2012 Summer Workshop Registration

WHPRMS 2012 Summer Workshop
June 19, 2012
9:00 a.m.—4:00 p.m.
Check in opens at 8:00 a.m.

Country Springs Hotel, Pewaukee, WI
2810 Golf Road
Pewaukee, WI 53072

$125 WHPRMS/WHA Members
$150 WHPRMS/WHA Non-Members

* Once you submit your application, you will be taken to a secured location via PayPal to pay for the Spring Workshop. If you do not wish to pay electronically, you may send a check, payable to WHPRMS, and send to:

Nicole Barreau
WHPRMS Education Chair
301 S. Westfield Rd., Suite 250
Madison, WI 53717

If you have questions, please email , WHPRMS Education Chair, or call her at (608) 265-1618.

Seating is limited so register early. Payment must be submitted via PayPal or a mailed check by June 5, 2012 to reserve your spot.

WHPRMS/WHA Member:

First Name:
Last Name:
Organization:
Title (optional):
Mailing Address :
City:
State:
Zip Code:
Telephone:
*Fax (optional):*
E-mail Address:

Fee:	$125 WHPRMS/WHA Member
	$150 WHPRMS/WHA NON-Member

Payment:	By check *See Nicole Barreau's info above
	Via PayPal (you will automatically be taken to PayPal when the application is submitted)