REGISTRATION FORM

Workers' Compensation Breakfast Seminar 2026 • Tuesday, September 15, 2026 - 8:30 AM

(Early-Bird price before Tuesday, September 15, 2026) • DSB09152026WORKE

Location:

Georgetown - Tunnell & Raysor Dover - Morris James Seaford - Aleman & Associates Riverfront

Registration Type:

$215.00 - Early Bird Member $215.00 - Member $190.00 - Early Bird Government $190.00 - Government $315.00 - Non-Member

PA Credit - Add $12.00 : PA ID No.

NJ Credit - Add $12.00 : NJ ID No.
The full name of the registrant
Your Delaware ID Number (Bar ID)
The voice phone of the registrant
The employer or firm of the registrant
The employer or firm address of the registrant
The total payment submitted with this form

Please make checks payable to DSBA

Credit Card
Please enter your payment method
Credit Card expiration date (MM/YYYY)
Enter CVV
The credit card number to be used for payment

Signature (Required for credit card purchases):

General Information

Return registration form to Delaware State Bar Association, 704 N. King St., Suite 110, Wilmington, Delaware 19801, or by email: reception@dsba.org copying accounting@dsba.org. A confirmation will be emailed to the registrant. Please keep a copy of this form as your receipt. CANCELLATION POLICY: Registrants may receive a full refund less a $25 cancellation fee for live seminars, if request is made in writing and received no later than one week prior to the seminar. PA CLE Credit will be reported according to the PA CLE Board rules: www.pacle.org. Unpaid registrants who fail to attend are responsible for the full cost of the live seminar. A registration for a live seminar may be transferred to another attorney. Call DSBA at (302) 658-5279 for more information. Visit www.dsba.org for all seminar policies.

For Office Use Only

PLEASE EMAIL YOUR COMPLETED FORM TO RECEPTION@DSBA.ORG AND COPY ACCOUNTING@DSBA.ORG

 

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