Attendee Registration - Public Defender Las Vegas Retreat

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Attendee Registration Form - 12th Public Defender Las Vegas Retreat April 27-29, 2012

For each attendee,
print out this page, fill it in, and mail to:
Dave Rendahl, Deputy Public Defender,
Tulare County Public Defender's Office,
County Civic Ctr, Rm G35,
Visalia CA 93291 USA

Or FAX this page to 1-559-733-6113. Please make check or money order payable to Dave Rendahl / Public Defender Retreat.
Or copy and paste this page into an email, fill it in (replace underlines with your answers), and send to Dave@PublicDefenderRetreat.com. (If you register by email, you may submit your credit card information by phone, FAX, or snail mail if you wish.)

Name: __________________________________________ Title / Office: ___________________________________

Address: ________________________________________ Email Address: __________________________________

City: __________________________ State: ____ Zip: ________ State Bar or Prof. # (optional): ________________

Phone: _________________________ Cell Phone: _______________________ Fax: ________________________

All attendees who register before Feb 29 will be entered to win either a black leather Las Vegas logo rolling
garment bag or a women’s red leather business tote bag/purse, each a $200 value, provided by the LVCVA.

Description	Cost Ea	Qty	Total
Retreat Conference Registration Fee: $110 before Feb 29, $130 after Feb 29 (or $150 at the Door): Please submit proper amount based on date of registration, one attendee per form. . . . . . . . . . . . . . . . . . . . . . . . . .	$______	______	$_______
Friday Night Human Nature Show: 7:30pm in the Imperial Theatre at Imperial Palace. Ticket price includes taxes and fees. Doors open at 7pm. . . . . . . . .	$45	______	$_______
Saturday Night Dinner & Show: 6pm in BB King's Blues Club at Mirage. Includes premium seat, 3 course dinner, live music, tax, and gratuity. Beverages NOT included. Doors open at 5:30pm, music show starts at 7pm. Menu (PDF) . . . . . . . . . .	$55	______	$_______
Sunday Afternoon World Defender Poker Tournament: 2pm at Tuscany. Print name(s) of entrant(s) below, use extra sheet if needed: ___________________________________________________________________	$65	______	$_______
Total Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	. . . . . .	. . . .	$_______

I am Paying by Check: [ ] Money Order: [ ] or Charge To: Visa: [ ] MasterCard: [ ] AmEx: [ ]

Name on Card: _____________________________________ Signature: ___________________________________

Card Billing Address: _____________________________________________________________________________

Card Number: ____________________________________________________ Expiration Date: _________________

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Retreat Activities:   (You're not committed, but to help us with planning.)

I Plan to Stay at Tuscany Suites: [ ]   Or Other Hotel: ___________________________________________________

Friday Welcome Party 4pm to 7pm at Tuscany (FREE): How Many Attending:  _____ Or If Not Attending: [ ]

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* The Tulare County Public Defender certifies that this activity has been approved for MCLE credit by the State Bar of California in the amount of 11 hours (with 2 of the hours in ethics). Tulare County Public Defender is a State Bar of California MCLE approved provider. We routinely get MCLE pre-approval in a number of states, and I will assist any attendee with CLE credit in their jurisdictions. Contact Dave at his office 559-636-4500, cell 559-827-7487, or Email for MCLE/CLE info on your state or jurisdiction (no state has ever denied credit for prior Retreats).
* For Canadian attendees, the Law Society of Upper Canada has accredited the 12th Annual Public Defender Las Vegas Retreat, held April 27-29, 2012, as follows: This program has been accredited by the Law Society for 2 Professionalism Hours. It is also eligible for up to 9.5 Substantive Hours for experienced members.

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