*Required fields in bold.

If you have more than one winner, please submit individual forms for each or print individual forms and e-mail as a set:  Health Law, Intellectual Property Law, and Labor Law.

*In the Study of
Select One Health Law Intellectual Property Law Labor and Employment Law

*Your Name

School Information

*Dean

*School

*School Address

*City

*State

*Zip

*Phone

Fax

*Email Address

Student Information - This Year's Winner

If you have more than one winner, please submit individual forms for each or print individual forms and e-mail as a set: Health Law, Intellectual Property Law, and Labor Law.

*Name

*Student Address

*City

*State

*Zip

*Send Certificate to Law School for Presentation
Yes    No

*Send Certificate Directly to Award Winner
Yes    No

*Do not contact winner prior to

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