NCLDB 2023 Annual Meeting/Dues Form

Please use this form to register for the 2023 Annual Meeting and/or pay your jurisdiction's annual dues ($100).

Annual meeting registration fees

$425 per person (in-person attendance)
$275 per person (virtual attendance)

I want to*

Pay dues and register for the Annual MeetingPay dues onlyRegister for the Annual Meeting only

Name of Discipline Authority*

Address*

Street Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry

Primary Contact*

Email*

example@example.com

Office Phone*

Click here to download a dues statement.

Your jurisdiction's NCLDB membership includes all individual board members, referees or other adjudicators, as well as all staff. Please list below all those who wish to be part of your NCLDB membership. For those who wish to also join the NCLDB email listserve, please include their email address.

Add other members here (they will be subscribed to the NCLDB listserv, no need to include folks who are already on the listserv)

Dues Amount

Registration fee used in internal form calculations (it will automatically update, no input necessary)

NATIONAL COUNCIL OF LAWYER DISCIPLINARY BOARDS
2023 ANNUAL MEETING

FEBRUARY 7-9, 2023

Registration Fee: $425 per attendee (in-person); $275 per attendee (virtual).

You may pay by credit card through Paypal, or send a check payable to NCLDB, to James T. Phalen, D.C. Board on Professional Responsibility, 430 E Street, NW, Washington, D.C. 20001 jtphalen@dcbpr.org

Name*

Title*

E-mail*

Cell Phone*

For contact during the conference

In-person or virtual?*

In-person ($425 per person)Virtual ($275 per person)

Do you need additional dinner tickets?*

No1 additional ticket ($125)2 additional tickets ($250)3 additional tickets ($375)

Registration fee

Register another attendee?*

YesNo

Name*

Title*

E-mail*

example@example.com

Cell Phone*

For contact during the conference

In-person or virtual?*

In-person ($425 per person)Virtual ($275 per person)

Do you need additional dinner tickets?*

No1 additional ticket ($125)2 additional tickets ($250)3 additional tickets ($375)

Registration fee

Register another attendee?*

YesNo

Name*

Title*

E-mail*

example@example.com

Cell Phone*

For contact during the conference

In-person or virtual?*

In-person ($425 per person)Virtual ($275 per person)

Do you need additional dinner tickets?*

No1 additional ticket ($125)2 additional tickets ($250)3 additional tickets ($375)

Registration fee

Register another attendee?*

YesNo

Name*

Title*

E-mail*

example@example.com

Cell Phone*

For contact during the conference

In-person or virtual?*

In-person ($425 per person)Virtual ($275 per person)

Do you need additional dinner tickets?*

No1 additional ticket ($125)2 additional tickets ($250)3 additional tickets ($375)

Registration fee

This form has a maxumim of four registrants. Please complete another form for any additional registrants.

Total if paying by check

Total if paying by paypal/credit card (including processing fees)

I would like to pay by*

CheckPaypal/Credit Card (processing fee will be calculated below)

Paypal Total

USDDescription

Email for registration confirmation*

example@example.com