WACE 6th Annual Symposium on Work Integrated Learning
 

ONLINE REGISTRATION FORM

(Individual Registration Submission for Each Registrant)
Date:
Honorific:
Last Name:
First Name:
Job Name / Designation:
Preferred Name on
Symposium Badge:
University / Organization:
Address:
City:
State/ Province:
Postal Code:
Country:
Phone:
Fax:
Email:
WACE Member:


REGISTRATION PAYMENT
Registration Fee: (Early Registration by September 15, 2007)
WACE Member:
WACE Non-Member:
US $375
(by 9/15/07)
US $475
(after 9/15/07)
US $475
(by 9/15/07)
US $575
(after 9/15/07)
US$
Guest Fee (@ US $175):
US$
* Guest Fee includes: Attendance at Symposium Lunch, Dinner and Reception
Guest Name(s):
US$
Select Payment Option:
   ( To pay by check please see below )
Credit Card # (No Dashes):
Expiration Date:
Credit Card Name:
(as it appears on credit card)
Address:
City:
State/ Province:
Postal Code:
Country:
Phone:

World Association for Cooperative Education WACE
WACE Federal Tax ID # 04-3279172

If Paying by Check Send Registration Form and Payment to:

Michelle Lennox, Director
6th Annual Symposium on Work Integrated Learning
World Association for Cooperative Education
360 Huntington Avenue, 384 CP
Boston, Massachusetts  02115-5096

Please make checks payable to: WACE

Forms received without payment will not be processed until payment is received. Cancellation fee $50 prior to October 5, 2007.
No refunds after October 5, 2007. There will be a $50.00 charge for all returned checks.

For registration questions contact Michelle Lennox, WACE (617) 373-8885

Please inform us if you need any special accommodations or have dietary restrictions: