Name*Spouse (if attending)Company NameTitleAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email PhoneHow Did You Hear About This Conference (Eagle Member Name or Other Communication)?Do You Require a Hotel Room (register by April 20th):YesNoHotel Arrival Date Date Format: MM slash DD slash YYYY Hotel Departure Date Date Format: MM slash DD slash YYYY Special Hotel RequestsNOTE: Hotel room reservations are made by completing this form and emailed to Terri Napolitani, not directly with the hotel. Payment will be made by presenting a credit card at check-in. Room Rate: $359 Check In: 4PM Check Out: 12PMMay 17: Will you be attending the Reception and Dinner? (By Invitation)YesYes, with spouseNoMay 18: Will you be attending the Seminar?YesYes, with spouseNoMay 18: Will you be attending the Lunch?YesYes, with spouseNoMay 18: Will you be attending Golf?YesYes, with spouseNoDo you need to rent clubs?LeftRightNoDo you need to rent shoes?YesNoShoe SizeDoes your spouse need to rent clubs?LeftRightNoDoes your spouse need to rent shoes?YesNoShoe SizeMay 18: Will you be attending Archery?YesYes, with spouseNoMay 18: Will you be attending Farewell Cocktails?YesYes, with spouseNo CONFERENCE FEES: ComplimentaryLEGAL CE: Credits pending for Illinois and Wisconsin. Please provide the following information for LEGAL CE CREDITS.Name as it Appears on Your LicenseIllinois License #Wisconsin License #Do you require a Certificate of Attendance to submit to your Bar as an individual?YesNoAdjuster CD Credits pending for Florida and Texas Please provide the following information for ADJUSTER CE CREDITS.Name as it Appears on Your LicenseFlorida License #Texas License # This iframe contains the logic required to handle Ajax powered Gravity Forms.