NJC COURSE REGISTRATION FORM Please fill in your details below. Fields in yellow are required. The NJC will never sell or rent your information to ANY third party. Contact Details Mr.  Mrs.  Ms.  Hon. First Name   Middle Initial   Last Name     F    M     Name you wish to appear on your nametag Name of CourtAgencyCompany   Office Address (Physical)   City     State     Zip   Office Phone     Ext.   Fax   Home E-mail Address   Position Details What is your position/function? (i.e. Chief Judge, Court Administrator, Military Rank)   Month/Year Elected/Appointed to the Position   Full TimePart Time Jurisdiction General Special Administrative Tribal Military Appellate Court Personnel Professional Population your court serves 0 - 50,000 50,000 - 250,000 250,000 - 500,000 500,000 plus Do you have a law degree? YesNo       Any other degrees?  What types of cases do you hear? (General, Special, Tribal, Appellate, Military)   Appellate Review Family Court Preliminary Hearing   Civil: Limit $ Civil: Unlimited Felony   Probate Criminal Jury Trial   Problem Solving Equity/Chancery Juvenile   Traffic Misdemeanor   What are the types of cases you hear? (Administrative Law)   Human Resources Public Utilities Unemployment   Labor Relations Personnel Welfare/Govt. Benefits   Licensing including employment discrimination Workers' Compensation   Motor Vehicle Social Security Natural Resources/Environmental     Tax   Course Details Have you previously attended an NJC course? Yes No If yes, have you ever served as an NJC group discussion leader? Yes No Would you like to serve as a discussion leader? Yes No Are you a Judicial Studies degree candidate? Yes No     If yes, year of admission Please list any dietary needs Please list any classroom logistic needs What specific problems would you like this course to help you solve? What specific skills do you hope to gain from this course? Please enroll me in (please be specific)  Course Date (if applicable) mm/dd/yy This is an online course Professional Certificate in Judicial Development Are you currently a Professional Certificate in Judicial Development candidate? Yes No   If yes, what year were you admitted? Please enroll me in the following Professional Certificate in Judicial Development   Administrative Law Adjudication Skills General Jurisdiction Trial Skills   Dispute Resolutions Skills Special Court Trial Skills   Tribal Judicial Skills   Payment Information (required) Invoice Me Invoice My Agency/Court Bill Name Billing Address City   State   Zip Agency Court Contact Name Contact E-mail Phone Number Purchase Order Number Pay with Credit Card If you are paying with a credit card: Please call NJC accounts receivable at (775) 327-8240 The National Judicial College is an Equal Opportunity/Affirmative Action, ADA organization, and admits participants of any age, race, color, gender, sexual orientation, national or ethnic origin.