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REGISTRATION FORM

ABA Tort Trial & Insurance Practice Section (TIPS) Fidelity & Surety Law Committee Public-Private Partnerships, Co-Suretyship, and Co-Insurance: Managing Risk Within Joint Ventures in Construction, Surety, and Fidelity

HOTEL DEADLINE: JANUARY 2, 2009 REGISTRATION DEADLINE: JANUARY 2, 2009 THIS FORM IS AVAILABLE ONLINE At: www.abanet.org/tips 1. REGISTRANT: (Please print or type one form per person; photocopy this form for additional registrants)

LAST NAME

FIRST NAME

MI

NAME AS YOU WISH IT TO APPEAR ON YOUR BADGE

FIRM/COMPANY

WHAT STATE(S) ARE YOU LICENSED IN?

ADDRESS

CITY

STATE

ZIP

(AREA CODE) BUSINESS TELEPHONE

FACSIMILE

E-MAIL ADDRESS

Insurance Company Employees: TIPS Members

no charge

Insurance Company Employees: non TIPS Members

$575

Government Employee

$575

TIPS Members

$965

Law Student

$300

General Attendee (all others)

$1,125

TOTAL ______ ______ ______ ______ ______ ______

Please check one:

_____

I will attend the Fidelity Sessions

_____

I will attend the Surety Sessions

2. REGISTRATION FEES:

SPOUSE OR GUEST (PRINT AS YOU WISH NAMES TO APPEAR ON NAME BADGE) How many Fidelity and Surety Law Committee Programs have you attended (including this one)?

QTY ____ ____ ____ ____ ____ ____

On or Before 1/2/09

_____

3 or less

_____

4 or more

After 1/2 $400 $600 $600 $995 $325 $1,150

/09

3. SOCIAL EVENT TICKETS: Welcome Reception (Attendee)

Spouse/Guest Welcome Reception Ticket Friday Luncheon (you must sign up to attend as space is limited) Spouse/Guest Friday Lunch Ticket Breakfast with FSLC UPBEAT Subcommittee (Thursday) Spouse Event (Thursday) Women’s Networking Breakfast (Friday)

4. TOTAL PAYMENT

____

______

$75 ($80 at door)

____

______

Included

____

______

$110

____

______

Free

____

______

$25

____

______

TOTAL

Free

Fee Included

QTY

____

______

(Add subtotals 2, 3 and/or 4) Total

______

PAYMENT INFORMATION ____Check (made payable to the ABA)

____

American Express

_____

MasterCard

_____

VISA

Credit Card Number

_____________________________________________________

Expiration Date

______________

Signature____________________________________________________________________________________________

5. MEMBERSHIP APPLICATION _______ I am a member of the ABA and wish to join the Tort Trial & Insurance Practice Section’s Fidelity & Surety Law Committee. I have enclosed a separate check for $50 made payable to the American Bar Association.

THREE WAYS TO REGISTER 1. ONLINE: www.abanet.org/tips

2. MAIL:

3. FAX:

Public-Private Partnerships, Co-Suretyship, and Co-Insurance: Managing Risk Within Joint Ventures in Construction, Surety, and Fidelity 75th Annual Midwinter CLE Meeting American Bar Association Tort Trial & Insurance Practice Section 321 North Clark Street 18th Floor Chicago, IL 60654 312/988-6230 On-site registrants must pay the program fee plus an additional $25 with a check made payable to the American Bar Association.

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