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prson Name____________________________________________ Traveling with (circle one) ECBF / UCBF / TANJ/Other Firm_______________________________________________ Email Address ____ @ ______________ Address ____________________________________________________________________________________ City ______________________ State _____________ Zip _______ Telephone (W) __________ (H) ___________ Arrival Date ________________ Special Accommodations / Request _____________________________________ Payment Amount: $ __________________ ( ) Check Check Number _________ ( ) MC / Visa Card # ______________________________________ Exp. Mm/Yyyy ________________________ Name on Card ____________________ Signature ____________________________________________________ Golf Tournament: # of Players_____ Golfers Names________________________________________________________________ Welcome Cocktail Reception February 8, 2006 6pm: Yes, I will attend ____ I regret that I can not attend_____ Names of persons attending reception:___________________________________________________________________________ The Essex County Bar Foundation (ECBF), Trial Attorneys of New Jersey (TANJ)and the Union County Bar Association (UCBA) explicitly decline any liability or responsibility for any related travel problems or losses. The conference member understand that he/she has no claim against the ECBF/TANJ/UCBA for any delay or damage to or loss of property/baggage or injury to or death of person(s) due to any negligent or willful act of direct air carrier, hotels, railroad, motor coach, boat or person engaged in conveying the passenger carrying out arrangement of the tour. Each individual conference attendee is responsible for their own air and hotel transfer arrangements. Travel insurance is available through South Mountain Travel and is highly recommended. All rates are based on tariffs at the time that the tour was booked and are subject to change Signature __________________________________________________ Date __________________ |
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