REGISTRATION FORM INTA/USPTO ROUNDTABLES · PDF fileREGISTRATION FORM INTA/USPTO ROUNDTABLES...
1
REGISTRATION FORM INTA/USPTO ROUNDTABLES March 14, 2013 Please type or print: Mr. Mrs. Ms. First Name Last Name Job Title Company/Firm Street Address City State Country Zip Postal Code Telephone Facsimile Email Address LOCATION Kilpatrick Townsend & Stockton LLP 1100 Peachtree St NE, Suite 2800 Atlanta, Georgia 30309-4528 DATE Thursday, March 14, 2013 Lunch: 12:00 pm Discussion: 12:30 pm–2:30 pm Registration Fee The registration fee is US $45.00 RGT RGTUQPRGT UGUUKQP CPF KPENWFGU C DWHHGV OGCN 6JG HGG KU PQPTGHWPFCDNG WRQP EQPƁTOCVKQP QH VJKU registration by INTA. If you are unable to attend, you may send a substitute. The roundtable will be limited to WZHQW\ÀYH CVVGPFGGU CPF TGUGTXCVKQPU CTG CEEGRVGF QP C ƁTUVEQOG ƁTUVUGTXGF DCUKU 7RQP TGCEJKPI capacity, a waiting list will be created. If a seat becomes available, you will be contacted immediately. All registrations must be made no later WKDQ GD\V EHIRUH WKH VFKHGXOHG URXQGWDEOH. All roundtable registrants must be pre-registered; WKHUH ZLOO EH QR RQVLWH UHJLVWUDWLRQV. Registra- tion by mail is not preferred. Payment To secure your reservation, please fax your registration with credit card information to the International Trademark Association, 6Q EQPƁTO [QWT TGIKUVTCVKQP RNGCUG EQPVCEV VJG %WUVQOGT 5GTXKEG &GRCTVOGPV CV customerservice@inta.org. The only acceptable method of payment is by credit card. American Express Discover MasterCard Visa Name as it appears on credit card Card Number Expiration Date CVV#* Signature * The CVV# Secure code is a 3 or 4 digit code printed on your credit card. We require this code as a security measure to our customers to ensure that the credit ECTF KU RTGUGPV CV VJG VKOG QH RWTEJCUG +H [QW ECPPQV ƁPF VJKU EQFG QT KV KU KNNGIKDNG RNGCUG EQPVCEV [QWT ETGFKV ECTF KUUWGT Visa, Mastercard and Discover Cards: The Secure code is the 3 digit value printed on the signature panel located on the back of your card. It is the last 3 numbers in that area. American Express Cards: The Secure code is the 4 digit value printed (not-embossed) above your account number on the front of your card. CLE CLE credits are not offered for roundtables. You can apply for CLE credits individually from your state bar.
Transcript of REGISTRATION FORM INTA/USPTO ROUNDTABLES · PDF fileREGISTRATION FORM INTA/USPTO ROUNDTABLES...
REGISTRATION FORM
INTA/USPTO ROUNDTABLES
March 14, 2013
Please type or print:�Mr. �Mrs. �Ms.
First Name Last Name Job Title Company/Firm
Street Address City State Country Zip Postal Code
Telephone Facsimile Email Address
LOCATION
Kilpatrick Townsend & Stockton LLP1100 Peachtree St NE, Suite 2800Atlanta, Georgia 30309-4528
DATE
Thursday, March 14, 2013Lunch: 12:00 pmDiscussion: 12:30 pm–2:30 pm
Registration Fee
The registration fee is US $45.00�RGT�RGTUQP�RGT�UGUUKQP�CPF�KPENWFGU�C�DWHHGV�OGCN��6JG�HGG�KU�PQPTGHWPFCDNG�WRQP�EQPƁTOCVKQP�QH�VJKU� registration by INTA. If you are unable to attend, you may send a substitute.
The roundtable will be limited to WZHQW\�ÀYH������CVVGPFGGU��CPF�TGUGTXCVKQPU�CTG�CEEGRVGF�QP�C�ƁTUV�EQOG��ƁTUV�UGTXGF�DCUKU��7RQP�TGCEJKPI�capacity, a waiting list will be created. If a seat becomes available, you will be contacted immediately. All registrations must be made no later WKDQ�����GD\V�EHIRUH�WKH�VFKHGXOHG�URXQGWDEOH. All roundtable registrants must be pre-registered; WKHUH�ZLOO�EH�QR�RQVLWH�UHJLVWUDWLRQV. Registra-tion by mail is not preferred.
Payment
To secure your reservation, please fax your registration with credit card information to the International Trademark Association, ����������������6Q�EQPƁTO�[QWT�TGIKUVTCVKQP��RNGCUG�EQPVCEV�VJG�%WUVQOGT�5GTXKEG�&GRCTVOGPV�CV�[email protected].
The only acceptable method of payment is by credit card. � American Express � Discover �MasterCard � Visa
Name as it appears on credit card
Card Number Expiration Date CVV#*
Signature
* The CVV# Secure code is a 3 or 4 digit code printed on your credit card. We require this code as a security measure to our customers to ensure that the credit ECTF�KU�RTGUGPV�CV�VJG�VKOG�QH�RWTEJCUG��+H�[QW�ECPPQV�ƁPF�VJKU�EQFG��QT�KV�KU�KNNGIKDNG��RNGCUG�EQPVCEV�[QWT�ETGFKV�ECTF�KUUWGT� Visa, Mastercard and Discover Cards: The Secure code is the 3 digit value printed on the signature panel located on the back of your card. It is the last 3 numbers in that area. American Express Cards: The Secure code is the 4 digit value printed (not-embossed) above your account number on the front of your card. CLE CLE credits are not offered for roundtables. You can apply for CLE credits individually from your state bar.
