TO REGISTER: Please complete the online registration form below. Fields in red are required. If you have questions, or wish to register offline, please contact NELI at: Phone 303-861-5600 Fax 303-861-5665 Email neli@neli.org Our cancellation policy will go into effect once you receive confirmation from our Registrar. Please refer to this policy in our brochure before submitting your registration Program Course Name Pregnant Workers Fairness Act Webinar Location / Date - please select - Web/TeleConference - June 15, 2023 Registration Fee $299.00 Please see the program brochure or e-mail neli@neli.org for registration fee schedule. Registrant Information Full Name Organization Title Mailing Address City State/Province - please select - Outside United States/CanadaAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IsNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory Zip/Postal Code Phone Number Email Address CLE Credit For CLE credit, please provide states(s)and bar number(s). Additional Email Address Include any additional email addresses that need to receive the receipt. Payment Information Payment Method American Express Discover MasterCard VISA Card Number Expiration Date (MM/YY) Cardholder's Name (as shown on card) Billing Address City State/Province - please select - Outside United States/CanadaAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IsNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory Zip/Postal Code Accommodations / Comments Special Accommodations Do you require any accommodation due to a disability to attend this program? No Yes If so, please describe below. Comments Please include any special instructions, questions, or other comments here.
