IPLI2023 SCHOLAR INFORMATION Name (Preferred)*HNBA Membership is required to participate in IPLI. Law student membership is free. CLICK HERE to sign up. HNBA membership*I confirm that I am a current HNBA Member.__________________________IPLI2023 SCHOLAR TRAVEL INFORMATION(Travel dates will be on Sunday, June 4th, and returning the following Saturday, June 10th.) Name (Must match ID you will be using to travel)* Sex*MaleFemaleNon-binary Age* Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Email* Phone* Departure City/State* City State / Province / Region Specific Airport* Do you have any dietary restrictions or do you require any special accommodations? If so, please provide details.__________________________BIO AND PROFESSIONAL HEADSHOT(Your bio and headshot will be published in the IPLI2023 booklet. Please proofread before submitting this form.) Bio (max 750 characters)* Hometown* Law School* Law School City, State* Law School Grad Year* Undergraduate School* Undergraduate School City, State* Undergrad Grad Year* Professional Headshot (min 300 dpi, jpg/jpeg files only)*__________________________EMERGENCY CONTACT INFORMATION Emergency Contact Name*FirstLast Emergency Contact Relationship* Emergency Contact Phone* Emergency Contact Email*__________________________DRESS CODESunday, June 4: Smart CasualMonday - Friday, June 5 - 9: Business Professional Dress Code*I understand and will comply with the dress code.__________________________REQUIRED AGREEMENTSHNBA/VIA IPLI2023 Individual Release Indiv Release*I confirm that I have read, understand, and agree to the above HNBA/VIA IPLI2023 Individual Release linked above.HNBA/VIA Code of Conduct Code of Conduct*I confirm that I have read, understand, and agree to the above HNBA/VIA Code of Conduct linked above. Addition CaptchaSubmitReset
