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Personal Information
 indicates
required field
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First
Name:
(as it will appear on your name badge) |
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Last
Name: |
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Title:
(as it will appear on your name badge) |
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Organization: |
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Address |
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City: |
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State: |
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Zip
Code:
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Telephone:
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Cell Phone: |
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Email:
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Invited by: |
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I have a promotional code: |
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Accommodations
(Please DO
NOT contact the hotel for reservations)
Littler will secure accommodations
at the The Westin Kierland at the rate of $249.00 plus tax. Please indicate your arrival and departure dates
below. You are responsible for payment
of room, tax and incidentals at checkout.
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Requested Arrival Date: |
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Requested Departure Date: |
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Requested Room Type: |
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Accommodation Requests:
(Other dates, Accessibility) |
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Credit Card Required for Room
Guarantee
Please provide a credit
card below to guarantee your accommodations. This card
will not be charged unless you cancel within 72 hours of your
arrival date.
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Credit
Card Type:
"No Room" Option in
drop down
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Credit Card Number:
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Expiration:
(January 2013=0113) |
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MCLE Credits
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I need MCLE Units, indicate State: |
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I need MCLE Units, indicate
State: |
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I need MCLE Units, indicate
State: |
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s Notes for MCLE Credits |
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Other Information/font> |
List Access,
Diet or other Special
Considerations: |
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