printable form
2012 WACTE Annual Conference
April 19 & 20, 2012
Radisson Paper Valley Hotel, Appleton, WI
Online Registration Form
For more information on the conference see the schedule and housing form.
First Name * MI Last Name *
Employer *
Address *
City * State * Zip Code *
Work Phone * Ext. Home Phone (example: 000-000-0000)
Email *
WACTE Membership # Local Association
Not a member? Click here to join!
Early Bird Full Conference (before 1/31/12): member $220 non-member $285
Full Conference (after 1/31/12): member $235 non-member $300
Special Pricing: Student $105 Spouse $170 Retired $95
One Day:
Thursday, April 19, 2012 member $160 non-member $220
Friday, April 20, 2012 member $160 non-member $220
* All conference attendees will receive a box lunch regardless if you choose to or not to participate in the walk
Registration fee includes continental breakfasts, lunches, breaks and registration materials.
*Choose One: Check Purchase Order Check# or PO#* *if PO # or Check # is not available please enter “to follow”
A $25 administrative fee will be charged for ALL cancellations. NO REFUNDS WILL BE ISSUED AFTER February 24, 2012.
Conference Attendance Accessibility/Special Needs: If you need disability-related accommodations or have special dietary requests, while in attendance at the conference, please identify below:
By submitting this form you are registering for the conference and agreeing to send payment as indicated above immediately. Online registrations will be treated the same as mail in and call in registrations.
NOTE: All fields with an * following them must be filled in.