Teaching Law for Engaged Learning Registration Form

Name: _______________________________________________

Phone: ______________________ Fax: __________________

School: _____________________________________________

Address: ____________________________________________

City/State/Zip: _____________________________________

E-mail: _____________________________________________

Conference price is $195 (includes hors d'oeuvres
  on April 9 and breakfast and lunch on April 10)

Method of Payment:

__ Check, payable to Elon University, for $195.00
__ Credit card (complete the credit card payment
    information requested on p. 2)

Return this form with your check or credit card information to:

Logo: Center for Engaged Learning in the Law. Center for Engaged Learning in the Law
Elon University School of Law
Attn: Jane Law
201 North Greene Street
Greensboro, NC 27401.

If paying by credit card, you may also fax the registration form and the credit card payment information requested below on p. 2 to:
(336) 691-1059.

For information or help with registration, call Jane Law at Elon at (336) 278-9325.

Credit Card Payment


   Cardholder Name: _________________________________

   Address: _________________________________________

   City/State/Zip: __________________________________

   Daytime Phone: ___________________________________

   Type of Credit Card and Number:
     __ Visa card #__________________________________
        ____ 3-digit CIV # on back of card

     __ MasterCard #_________________________________
        ____ 3-digit CIV # on back of card

     __ AMEX card #__________________________________
        _____ 4-digit security code on front of card

   Exp. Date: _____________

   Billing Zip Code: ___________________________

   Amount to be charged: $______________________

   Signature: _______________________________________



For internal purposes
Credit Account No.
________________________     _________________________