Speed-Mingle with Queens County Judges Please enable JavaScript in your browser to complete this form.Name *FirstLastFirm *Email *Phone *Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you currently a member of QCWBA? *YesNoMember TicketsNumber of member tickets1 - $0.002 - $0.003 - $0.004 - $0.005 - $0.006 - $0.00Non-Member TicketsNumber of non-member tickets1 - $35.002 - $70.003 - $105.004 - $140.005 - $175.006 - $210.00Enter the names of attendee(s) below:Attendee 1 *Attendee 2 *Attendee 3 *Attendee 4 *Attendee 5 *Attendee 6 *Total Payment *$0.00PaymentStripe Credit Card *CardName on CardSubmit
