Online
Registration

-- The 2016 National Directory of Expert Witnesses --

To register for the 2016 edition of the National Directory of Expert Witnesses and Internet Online Directory, just fill out and submit the following online registration and order forms.You will receive a proof of your listing by regular mail within ten business days, and your listing will be added to the Online Directory as soon as you approve and return your proof.

Registration Form


Please note: this is a secure form -- all transmissions are  encrypted for safety. If you would prefer not to send credit card information online, you may mail your check or credit card payment separately. You may also register by regular mail or fax by requesting our Standard Registration Package.


 

Name:

Special  Instructions

(Click here for
detailed instructions)

Title:

Company:

Which do you want to appear at the top of your listing?

    Your Name (default) or
    Your Company Name

Select either Your Name or your Company  Name to indicate which you would like to appear at the top of your listing.

Address:

The base price of $265 includes one  mailing address, up to 3 phone numbers, one fax number, and an E-mail and/or Web site address. You may purchase additional addresses (up to 3 lines each) for $30 each  plus $15 for each additional phone/fax number. (Include additional addresses or other misc. information in the space provided at the bottom of this registration form)

City:

State:

Zip:

Tel. #1:

Tel. #2:

Tel. #3:

Fax:

E-mail:

Web site:


Enter a Subject Heading for Your Primary Listing
(included  in $265 base price):

Primary Listing:

Select a subject heading for your Primary Listing  (click here for list of headings). The base price of $265 includes one listing under one subject heading.

Enter Subject Heading(s) for any Additional Listings
(optional):

        Add $95 for each additional listing

2nd listing:

You may purchase additional listings under separate subject headings for $95 each  (click here for list of headings). Each additional listing includes a cross reference to your Primary  Listing.

3rd listing:

4th listing:


Specialties & Biographical Information
(Limit 90 words)

Use a total of up to 90 words to list your specialized areas of expertise and provide additional biographical information (click here  for sample listing).

List your specialties first using single words or short phrases separated by commas or semicolons.

Within the 90-word limit, you may provide additional biographical information on expert testimony experience, schools or universities, affiliations, honors/awards, previous positions, or any other relevant information.

Degrees, Licenses, Certifications
(Limit 50 characters)

List degrees, licenses, certifications, etc. up to 50 characters(additional information may be included with biographical info. above). Use standard abbreviations where possible. (Examples: "PhD, MS, MSME, MD, DMD, Lic. Contr., etc.")

Additional Address(es), Comments, Instructions

Use this space for additional addresses (add $30 per additional address plus $15 for each telephone/fax number), or for any comments or instructions.

 


Order Form

Yes, I would like to list my professional services in the 2010 National Directory of Expert Witnesses. As a bonus for registering online, I understand that I will pay the special online registration fee of $265 for an Extended Listing in the 2010 print directory. In addition to a listing in the print directory, I will also receive a free Online Listing in the Internet Online Directory, free referral services, and a complimentary copy of the print directory.   I also understand that I have the option to purchase additional directory listings for $95 each. I may also purchase additional office or branch addresses and/or a display advertisement in the print directory (see complete fee schedule). (Claims Providers of America reserves the  right to reject any application for listing in the directory.)


Registration Fees:

Directory Listing (sample)

$265 *

 

 

Additional Listings
(optional)

 

Add $95 for each additional listing selected above.

Additional Addresses
and/or tel./fax #s
(optional)

 

See fee schedule.

Display Ad
(optional)

 

See display ad rates & layouts.

Total Registration Fee

 

 

* Special reduced fee for registering online (see  fee schedule.).

Select type of payment:

 Visa/MasterCard American Express Discover Check to follow **

Card Number: Expiration Date:

 

Please note: this is a secure form -- all  transmissions are encrypted for safety. If you would prefer not to send credit card  information online, you may send your check separately (see below).


** Make checks payable to "The National Directory of Expert Witnesses." and mail to address below. Registration form cannot be processed until payment has been received.

The National Directory of Expert Witnesses
P.O. Box 270529
San Diego, CA 92198-0529
(800) 735-6660 Fax: (858) 487-7747

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