Pink or Blue Registration

Beyond "Pink or Blue" Workshop Registration

Saturday, May 7, 2005

Online Registration Form

For more information on the conference see our online brochure

The Milwaukee chapter of PFLAG is offering financial assistance for this conference. For details, please contact Will Fellows at wfellows@wecanaeyc.org, or 414-278-9322, ext 2006.

First Name ^* MI Last Name ^*

Employer ^*

Address ^*

City ^* State ^* Zip Code ^*

Phone ^* Ext.

Email ^*

Method of Payment^*

Registration fee is $100.00 and includes lunch, breaks and registration materials.

Choose One: Check Purchase Order

Check# or PO# ^*

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.

Attendance is limited to the first 150 registrants.

Registration deadline is May 6, 2005. Registrations are limited – First come, first served.

Cancellations: A $15.00 administrative fee will be charged for any cancellations. To request a refund before April 24, 2005, send a letter to:
WACTE
518 Potomac Lane
Madison WI 53719
No refunds will be issued after April 24, 2005.

NOTE: All fields with an^* following them must be filled in.