Office of Court Administration

First Name:

First Name

Last Name:

Last Name

Name of Court/Organization:

Name of Court/Organization

Phone:

Phone

Cell Phone:

Cell Phone

Fax:

Fax

E-mail:

E-mail

Mailing Address:

Street Address

City

State/Province

ZIP/Postal Code

Country

Your Position (if not listed above):

Your Position (if not listed above)

Type of Court (if not listed above):

Type of Court (if not listed above)

County (where interpretation services provided):

County (where interpretation services provided)

Name of a backup person in your court that we can contact if needed:

Name of a backup person in your court that we can contact if needed

That person's phone number:

That person's phone number

That person's e-mail address:

That person's e-mail address

Interpretation services requested by means of:

Interpretation services requested by means of

Speaker phone

Videoconference

Wireless headsets

Other or undecided

Are you currently set up for videoconferencing?:

Are you currently set up for videoconferencing?

Yes

Is there a microphone for each participant?:

Is there a microphone for each participant?

Yes

Additional comments about audio/video equipment available:

Additional comments about audio/video equipment available

Username:

Username

Password:

Password

Confirm Password:

Confirm Password

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