You may use this registration form to register online with your credit card for DRI's Personal Injury Potpourri. 

Please be advised that any information you submit will NOT be encrypted or secure.

You may also register by calling our registrar, Margie Pepe, at (215) 656-4374.

Name (Required)
Attorney ID # (R)
Year Admitted to the Bar (R)
Firm Name
Address (R)
City, State, Zip Code (R)
Telephone (R)
Fax
Email (R)
Credit Card (Visa, Mastercard, Amex) (R)
Credit Card Number (R)
Expiration Date (R)

Note: Please do not include any URLs in form.