Washburn Law Clinic 40th Anniversary Celebration
Registration Form

Registration Fee (for all activities):
$40 per person

Registrations are due by Wednesday, October 15, 2010.

Print and complete this page. Mail with your check (payable to: Washburn University School of Law) or credit card information to:

Washburn University School of Law
Attn: Debi Schrock
1700 SW College Ave.
Topeka, KS 66621-1140
Phone: (785) 670-1191
Fax: (785) 670-1094

Name:     _____________________________________________

Firm/
Business: _____________________________________________

Address:  _____________________________________________
          Street

          ______________________________________________
          City               State                 Zip

Phone:    ______________________________________________

E-mail:   ______________________________________________

Guest Name: ____________________________________________

___ CLE (9:00 – 10:40 a.m.) 
    Number attending ______

___ Tailgate Party (11:30 a.m. – 1:00 p.m.)
    Number attending ______

___ Football game (1:00 p.m. kick-off)
    Number attending ______

___ Cocktail Reception and Dinner (6:00 p.m.)
    Number attending ______

___ I request a vegetarian meal.
___ My guest requests a vegetarian meal.

___ I will be unable to attend.

Registration Fee (for all activities): $40 per person

Total enclosed or to be charged to credit card: $ ______

Credit Card (circle one): MasterCard, Visa, Discover

Card No: _______________________________  Expiration ____________

Signature: ___________________________________________

Assistance for Special Needs:
If you require any special services or auxiliary aids to assist you while attending the program, please contact Debi Schrock at (785) 670-1191.

Washburn Law Clinic 40th Anniversary CelebrationRegistration Form

Washburn Law Clinic 40th Anniversary Celebration
Registration Form