Education Day - Meet & Play in Wisconsin MPI-WI
 

Lunch & Tradeshow Only Registration

Primary Registrant Information
Full Name:
Title/Position:
Company/Affiliation:
Address:
City: State: Zip:
Phone: Fax:
Email Address:

Please indicate the following (check all that apply)
I am an MPI member
I’m attending my first MPI-Wisconsin Chapter meeting
I’d like to contribute to the Education Fund $

Registration Fees

  Tradeshow & Lunch Only — $19.

Additional Attendees from Your Company: x $19 each.

  Full Name (as will appear on badge) Email
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Needs
  If you have special dietary needs or require assistance with physical accomodations, please contact the MPI-WI chapter office at (608) 204-9816.

Method of Payment
Mastercard Visa American Express  
Credit Card Number:       Exp. Date:
Three digit verification number (on back of credit card):
Name as it appears on card:
Billing Address for Credit Card:

No refund will be given for cancellations after noon on Friday, November 7, 2008.