August 17, 2004 - Registration

Fax to: (608) 204-9818

Mail to: 2830 Agriculture Dr.
Madison, WI 53718

Full Name:

Title/Position:

Company/Affiliation:

Address:

City:		State:	Zip:
Phone:		Fax:	Email:

Which activities will you be attending? (check all that apply)
	1:00 p.m. "Personal & Professional Excellence" Educational Session
	5:30 p.m. Cruise on the Julia Belle Swain Steamboat

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. Amount: $
	I require special accommodations. (We will contact you to make arrangements.)
	I have special dietary restrictions. Please specify:

Registration Fees
	Member - $39 per person
	Non-Member/Late Registration –– $55
	Student Fee –– $25

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 Tuesday, August 10, 2004.



	MPI Wisconsin Headquarters 2830 Agriculture Dr. :: Madison, WI 53718 :: Phone: (608) 204-9816 :: Fax: (608) 204-9818 :: Email: admin@mpiwi.org

	© 1997 - 2003; Meeting Professionals International, Wisconsin Chapter All rights reserved