Individual Registration

Please enter information in the form below to process registration for event Lex on the Rocks January 24th.

First Name *

Last Name *

Phone *

Email *

You DO NOT have to have a Paypal account to register. Please scroll down to the bottom after processing registration and click the debit/credit card portion of Paypal's site.

Payment Information

Coupon

Amount

Discount Amount

Tax amount

Gross amount

Payment Method

Paypal

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

By registering for this event, I accept Terms and Conditions

Individual Registration

Payment Information

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