Judiciary Night Registration, 2025 Click here if you wish to sponsor this event. 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 CodeIf you are registering for the event, one of the following *Current dues paid member of QCWBAMember of the JudiciaryNone of the aboveMember TicketsNumber of member tickets1 – $0.002 – $0.003 – $0.004 – $0.005 – $0.006 – $0.00 person Email Total Non-Member TicketsNumber of non-member tickets: In person1 – $75.002 – $150.003 – $225.004 – $300.005 – $375.006 – $450.00Enter the names of attendee(s) below:Attendee 1 *Attendee 2 *Attendee 3 *Attendee 4 *Attendee 5 *Attendee 6 *Total Payment *$0.00PaymentAuthorize.Net *Card NumberMM123456789101112Expiration/YY2526272829303132333435Security CodeSubmit
