South Texas College of Law

MENTAL HEALTH LAW INSTITUTE:
co-sponsored with the
DISABILITY AND ELDER LAW ATTORNEYS ASSOCIATION
March 8, 2001

Registration Form

Registration Information

You must choose one:
$199 * for attorneys
$175 * for DELAA members
$125 * for legal assistants

* Tuition includes lunch, refreshments and course materials.


$75 for course materials only (hard copy format; tax & shipping included)

NOTE: The "First Name," "Last Name," "Address," and "Daytime Phone Number" fields are mandatory.
First Name
Middle Name
Last Name
Firm Name

Address (Street or P.O. Box)

City
     		State
     		Zip
Texas Bar Card Number
     		Birth Month
Daytime Phone Number

Fax Number
E-mail Address
Send a copy of my registration information to the e-mail address above.
      (Note: Any credit card information you provide below WILL be included.

    Please include me on your mail list (U.S. Mail) for future programs.
    Please include me on your e-mail list (listserv) for future programs.
    Please include me on your fax list for future programs.

Payment method (we accept Visa or MasterCard) :

      Please charge my 
 
Account Number (no dashes or spaces)
Exp. Date (mm/yyyy)
Other Information:

      
No data is submitted by previewing this information.