homesupportsearch
 
 

Home > Events > Child Policy Forum 2008 > Child Policy Forum 2008 Registration Form

2008 WisKids Count
Child Policy Forum

a special luncheon presentation with
Dr. T. Berry Brazelton and Dr. Joshua Sparrow:

Touchpoints: Building Families,
Strengthening Communities

Thursday, November 20, 2008, Noon-1:30 PM
Monona Terrace, Madison Wisconsin

REGISTRATION DEADLINE IS NOVEMBER 14TH

Please Note: Cancellation refund requests will be
accepted only until 5 PM on November 14th.

REGISTRATION FORM


LUNCHEON IS $40.00 PER PERSON

Total number of luncheon tickets you wish to purchase is:
one ($40) two ($80) three ($120) four ($160)
five ($200)

*If you wish to purchase more than five tickets, please contact Wenona Wolf at (608) 284-0580, ext. 304.


Please Note: If you are NOT attending the luncheon, but only registering others, please provide your contact info in this section:
Contact's First Name:
Contact's Last Name:
Contact's Organization/Company:
Contact's Work Phone:
Contact's Email Address:
   
(1)REGISTER FIRST PERSON BELOW:
First Name:
Last Name:
Occupation:
Organization/Company:
Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Email Address:
Phone (Home):
Phone (Work):
Check any that apply below:
Please provide a vegetarian meal for me/this registrant.
I would like to receive more information about WCCF.

How did you hear about this event? Please tell us below.
 

If you have registered yourself and/or one other person above and do not wish to register anyone else , click here to proceed to payment options and SUBMIT REGISTRATION button at the end of this form.

To register more people, please continue filling out the form below.

(2)REGISTER 2ND PERSON BELOW:
First Name:
Last Name:
Occupation:
Organization/Company:
Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Email Address:
Phone (Home):
Phone (Work):
Please provide a vegetarian meal for this guest.
 
(3) REGISTER 3RD PERSON BELOW:
First Name:
Last Name:
Occupation:
Organization/Company:
Address 1:
 
Address 2:
City:
State:
Zip/Postal Code:
Email Address:
Phone (Home):
Phone (Work):
Please provide a vegetarian meal for this guest.
 
(4) REGISTER 4TH PERSON BELOW:
First Name:
Last Name:
Occupation:
Organization/Company:
 
Address 1:
 
Address 2:
City:
State:
Zip/Postal Code:
Email Address:
Phone (Home):
Phone (Work):
Please provide a vegetarian meal for this guest.
 
(5) REGISTER 5TH PERSON BELOW:
First Name:
Last Name:
Occupation:
Organization/Company:
 
Address 1:
 
Address 2:
City:
State:
Zip/Postal Code:
Email Address:
Phone (Home):
Phone (Work):
Please provide a vegetarian meal for this guest.


Questions regarding purchasing tickets for additional guests? Please call Wenona Wolf at (608) 284-0580, Ext. 304
 
PAYMENT OPTIONS: Please indicate payment option choice below.
Check. Make check payable to WCCF and mail to:
CHILD POLICY FORUM 2008
WCCF
555 West Washington Avenue, Suite 200
Madison, WI 53703
Credit Card. If you select credit card option, choose one of the following:
AFTER SUBMITTING REGISTRATION (below), you will be directed to a thank you page displaying link to a secure page and you may submit card information to make payment online, OR
AFTER SUBMITTING REGISTRATION (below), you may mail credit card info to address shown above, OR
AFTER SUBMITTING REGISTRATION (below), you may call (608) 284-0580, ext. 304 and speak to Wenona Wolf
Purchase Order Number:
Please note: all attendees are required to pay the registration fee in full prior to attending the luncheon.
Payment Questions? Contact Wenona Wolf at (608) 284-0580, ext. 304
 
 
Wisconsin Council on Children and Families, Inc.
555 West Washington Ave, Suite 200 • Madison, Wisconsin • 53703
Tel 608.284.0580 • Fax 608.284.0583