Schindel, Farman & Lipsius LLP

ONLINE REGISTRATION FORM

Please complete this form to register for the seminar.

Red indicates a field that must be completed.

Select a session: Automobile Liability Cargo

PARTICIPANT INFORMATION

Your Name:

Department:

Company Name:

Company Street Address:

Company City:

Company State:

Company Zip:

Company Telephone Number:

E-Mail Address:

Tuition: $895, includes course materials and breakfast and lunch both days. Please send $895 for each participant, payable to:

Schindel, Farman, Lipsius, Gardner & Rabinovich LLP
14 Penn Plaza, Suite 500
New York, New York 10122

Tuition is refundable if your cancellation is received by April 7, 2008. This on-line application will hold you spot for 14 days but payment must be received by then or the reservation may be cancelled.

You may elect to pay for the attendance at the seminar by credit card. Your card will be charged on April 7, 2008.

Cardholder Name:

Cardholder Billing Address:

Cardholder City, State, Zip:

Cardholder Daytime Telephone Number:

MasterCard Visa American Express Discover

Card Number:

Expiration Date:

CVV/CVC (The 4 digit non embossed number on the front of an American Express Card or the 3 digit non embossed number on the back of MasterCard or Visa):

HOTEL REGISTRATION

Date of Arrival:

Date of Departure:

Single Room Double Room

If double occupancy, name of person sharing room:

Smoking Non-Smoking

Rates: April 10 - April 13, 2008, $139; April 14 - April 16, 2008, $179.

Lodging: The hotel will bill participants directly. Please supply us with a major credit card number to guarantee reservations for persons arriving after 6 p.m. This credit card will not be used for seminar registration. it is to hold the hotel room only.

Credit Card Number:

Type:

Expiration Date:

COMMENTS

Please note that the confirmation you get when you submit this form is only confirmation that it has been transmitted to us. It is not confirmation that your registration has been accepted. You will be contacted regarding that.

If you do not hear from us within 24 hours, contact Blima Levine at (212) 563-1710, ext. 217 or send an e-mail.