Primary Registrant Information
  E-Mail Address:    
  Honorific    
  First Name:    
  Last Name:    
  Name to Appear on Conference Badge:
(If different from above)		    
  Job Title / Designation:    
  University / Organization:    
  Mailing Address:    
       
  City:    
  State / Province:    
  Country:    
  Postal Code:    
  Telephone Number:    
  Fax Number:    
         
  Registration Fees (Please note that all monetary values are in USD.)
  REGISTRATION (February 16, 2010 – June 1, 2010)
  WACE Member: $400USD   USD
  Non-Member: $525USD      
         
  OTHER REGISTRATION TYPES      
  Student: $175.00 USD   USD
         
  Guest(s): (@ $175USD per Guest)   USD
  If yes, please provide the Guest(s) name(s):
  Guest fee includes: Receptions, Conference Luncheons, and Conference Dinner
         
  TOTAL CONFERENCE CHARGES: $ USD
         
 

ATTENTION: Please Remember to Press "Calculate Total Charges" button above to verify final charges total.
  Payment Method
  ATTENTION: Payment by Credit Card REQUIRES ALL BILLING ADDRESS INFORMATION TO BE FILLED IN!
  Please Select Desired Form of Payment:
(See Instruction Below Regarding Payments)		    
         
  Credit Card Number (MasterCard or Visa Only):    
  Expiration Date (mm/yyyy):    
  Name on Card:    
  Billing Address (if different from above):    
       
  City:    
  State / Province:    
  Country:    
  Postal Code:    
         
 

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

If Paying by Check Send Registration Form and Payment to:
Michelle Hansford, Director
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 May 14, 2010. No refunds after May 15, 2010.
There will be a $50.00 charge for all returned checks.

For Bank Transfer, please contact the WACE Secretariat for our banking information @
m.hansford@neu.edu or via telephone @ 617-373-8885

For registration questions contact Michelle Hansford, WACE (617) 373-8885
  Please provide dietary restrictions: