FLORIDOM WEBINARS

REGISTRATION FORM

Scheduled Presentation Dates

Today’s Date : ALIMONY CHANGES WEBINAR – 4 OPPORTUNITIES ALIMONY 2016 April 15, 2016 May 13, 2016 Seminar Dates : ALIMONY 2016 July 22, 2016 Sept. 9, 2016

Options: List desired session dates or highlight or circle desired dates. Fax or email to Floridom. [email protected] Fax - 407-834-9745 PERSONAL INFORMATION Firm Name Contact Email address Phone Street address P.O. Box City State ZIP Code PAYMENT INFORMATION Fee is for each individual computer sign-on/ CLE Application. Fees are shown on flyers. American Express, MasterCard, Visa, Discover and company checks (received before the event date) are accepted. Check Number Fees are discounted for Court Personnel and Legal Aid Fee $ 129 Credit Card Type (ie., MC, Visa, AmExp) Name on CC Account CC Number CC Expiration Security Code CC Billing Address (if different than above)

Please return completed form to [email protected] or fax to 407-834-9745. You will receive registration confirmation and instructions via email in the days just before the event - you must register with our provider at that time, otherwise you will not receive sign on instructions. Presented by Floridom, Inc. 365 Wekiva Springs Rd., Suite 101 Longwood, FL 32779 407-834-7720 or 800-355-4206 Fax: 407-834-9745