FESTSCHRIFT REGISTRATION FORM

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Nov 20, 2013 (3 years and 8 months ago)

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NAME ￿
as you wish to have it printed on your name badge
￿
SCHOOL OR ORGANIZATION ￿JOB TITLE￿
MAILING ADDRESS
*

STREET ADDRESS CITY STATE ZIP
EMAIL ADDRESS ￿FOR REGISTRATION CONFIRMATION￿ AREA CODE TELEPHONE NUMBER


*We do not share, sell or distribute the contents of our mailing lists or e-mails to organizations outside UW-Madison.
Are you an alumnus/a of Educational Leadership & Policy Analysis? If so, year of graduation: __________
You may receive email and/or direct mail from the School of Education External Relations Office. To opt out check here.

If you have any dietary restrictions or require any other special accommodations, please indicate the information when you
register.
Any information provided will be kept confidential.
I WILL BE ATTENDING: AFTERNOON ACTIVITIES

EVENING BANQUET ￿$45￿

No refund requests will be hono
red after May 29, 2013.
MAKE CHECK OR MONEY ORDER PAYABLE TO:
University of Wisconsin–Madison
MAIL TO:
The most secure way to make payment is by credit card online at:
https://uonline.education.wisc.edu/course/category.php?id=24
If you prefer to make your credit card payment using this form, please complete the following information:
Credit Card Information
Please charge my payment of $45 for the banquet to:


MasterCard


Visa


Discover
CARD NUMBER

EXPIRATION DATE ￿MO/YEAR￿ 3 OR 4 ￿DIGIT SECURITY CODE
CARD HOLDER NAME AS IT APPEARS ON YOUR CREDIT CARD SIGNATURE
ADDRESS WHERE YOU RECIEVE THE BILL
FOR THIS CARD CITY STATE ZIP
Required for both afternoon and evening. Registration payment deadline is May 29, 2013

PLEASE PRINT or REGISTER ON-LINE AT:
https://uonline.education.wisc.edu/course/category
.php?id=24
FESTSCHRIFT REGISTRATION FORM