November 14-18, 2011
Charlotte-Mecklenburg, North Carolina

Name:

Agency:

Address:

City:

State:

Zip:

Phone:

(      )

Fax:

(      )

E-mail:

REGISTRATION FEE

Course registration

$500.

IALEP membership required for all attendees (new or renewal)

$75.

Payment enclosed

$                 

Print this registration form and mail with payment in U.S. dollars to:

IALEP

P.O. Box 11437

Torrance, CA 90510-1437

Class limited to 25 persons in order of receipt of payment.