REGISTRATION FORM

(SEATING IS LIMITED TO 300, SO PLEASE REGISTER EARLY)

Please mail this registration form with your check to:

Betty A. Ryberg
PROSKAUER ROSE LLP
1585 Broadway
New York, NY 10036

Enclosed is a check for $__________ made payable to the "CPLA" for the below specified registrants at $150 each.

Registrant's Name:___________________________________________________

Firm/Company: _____________________________________________________

Address:___________________________________________________________

__________________________________________________________________

Tel. No.: ___________________________________________________________

E-mail: ____________________________________________________________

I am interested in receiving Pennsylvania CLE Credit: Yes______ No ______

I am interested in receiving New York State CLE Credit: Yes______ No ______

Registrant's Name: __________________________________________________

Firm/Company: ____________________________________________________

Address:__________________________________________________________

_________________________________________________________________

Tel. No.: _________________________________________________________

E-mail: _________________________________________________________

I am interested in receiving Pennsylvania CLE Credit: Yes______ No ______

I am interested in receiving New York State CLE Credit: Yes______ No ______

For those registrants seeking NYS CLE Credits, full and partial scholarships to attend this program are available to judges, judicial law clerks, law professors, law students, government agencies, unemployed attorneys, and those with financial hardship. To apply for a full or partial scholarship, please send your request stating the reason for your interest in a scholarship to Anthony Giaccio, Chair of the NYIPLA Committee on Continuing Legal Education, c/o Baker Botts, 30 Rockefeller Plaza, 44th Floor, New York, NY 10112 along with the completed registration form for this program. Students are requested to submit a photocopy of their validated student identification card.