2012 Spring Conference Registration

Name
Agency or Business
Address
Telephone
Email


Professional Registrant     Student Registrant


Thursday ($115/$50)     Friday ($100/$50)     Both Days ($215/$100)  

Payment Method  
Will Mail Check or PO     Will Pay at Conference

Payments should be mailed to:

WIPCOD
P.O. Box 0174

Waukesha, WI           53187-0174