Video Rental Form

IN-HOUSE/SELF STUDY VIDEOTAPE RESERVATION REQUEST
Please Print and Fax Request to 706-389-7722
Rental Fee is due upon return of tapes to ICLE. There is a $5.00 per calender day late fee
for tape sets returned after the due date listed on the rental form you will receive with your tapes.

Name
Bar Number
Firm Name
Suite/Floor Number
Street Address (Necessary--Delivery is provided by UPS)
City
State
Street ZIP (ZIP+4)
Daytime Phone (xxx) xxx-xxxx
Program Name and Number
Video Format (VHS or DVD) where applicable
Number of Attendees
Please indicate ASAP, or list a 1st and 2nd choice of reservation dates for this program.
Your 2nd choice date MUST be at LEAST
14 days after your 1st choice date.
ASAP (indicate by typing "YES")
1st Choice Date
2nd Choice Date
.
You may fax your request to (706) 389-7722, or mail to: ICLE in Georgia P.O. Box 1885 Athens, GA 30603-1885

Name
Bar Number
Firm Name
Suite/Floor Number
Street Address (Necessary--Delivery is provided by UPS)
City
State
Street ZIP (ZIP+4)
Daytime Phone (xxx) xxx-xxxx
Program Name and Number
Video Format (VHS or DVD) where applicable
Number of Attendees
Please indicate ASAP, or list a 1st and 2nd choice of reservation dates for this program. Your 2nd choice date MUST be at LEAST 14 days after your 1st choice date.
ASAP (indicate by typing "YES")
1st Choice Date
2nd Choice Date
. You may fax your request to (706) 389-7722, or mail to: ICLE in Georgia P.O. Box 1885 Athens, GA 30603-1885