Pennsylvania Bar Institute

Bringing Excellence to CLE

Order & Registration Form

RELATED PAGES:  How to Register for Courses | How to Order Products

Print this form for mail or fax orders ONLY.
(Please note: Fax orders must be paid by credit card.)

This printable form is for the convenience of those who prefer not to use our online registration and order system.

NOTE: Do you want the early registration discount?

PBI must receive this form with payment 3 or more business days before the seminar; be sure to fax or mail your registration in plenty of time to qualify for this discount. Early registration helps us to keep our costs (and yours) down; we print books and order refreshments based on early registration numbers.

Customer Information:

Name _____________________________________ Atty No. _________________________________________________

Firm ______________________________________ Address* ________________________________________________

City ______________________________________ State ___________________________________________________

Zip _______________________________________ Phone __________________________________________________

County ____________________________________ Fax ____________________________________________________

E-mail address ______________________________

* Note: Please include street address. UPS will not ship to a post office box.

To Register for PBI Seminars:

_____ PBA Member _____ Paralegal

_____ County Bar Member _____ Judicial

_____ CPA _____ Other ______________________

• The ___________________________________ county bar will pay $_________ of the tuition fee.

• As a member of both the PBA and the _______________________________ county bar association, I intend to use my discount coupon in the amount of $__________ for my ___ 1st ___ 2nd ___ 3rd ___ 4th ___ 5th PBI seminar.

• I have enclosed $__________ for the optional luncheon/dinner at the ___________________________ seminar on ______________________________________.
  NOTE: If you are registering for one day of a two-day Institute, please specify which day.

To Order PBI Products:

_______ No Auto Update Service
Check here if the book you are ordering has an automatic update service, and you do NOT want to be enrolled in that service.

Payment Information

Check

A check for $_______ is enclosed. (Fax orders must be paid for by credit card.)

Credit Card

Charge my: _____ MasterCard _____ VISA _____ American Express | Amount: $____________

Credit Card Number ______________________________________ Expiration Date _____/_____

Authorized Signature ______________________________________________________________

Mail to:

Pennsylvania Bar Institute
5080 Ritter Road
Mechanicsburg, PA 17055-6903

Fax to:

717-796-2348

Do you want the early registration discount?

See above.

Source Code: 1740

PENNSYLVANIA BAR INSTITUTE | PBI | Phone: 800-247-4724  |  Fax: 717-796-2348  |  Email: info@pbi.org | Copyright