2009 WAHPERD Convention Pre-registration Form
Deadline: October 8th, 2009

You must be a current member of WAHPERD through 11/09 or return a new/renewal membership form with membership dues to pre-register for the convention. COMPLETE ALL INFORMATION AND CHECK ALL APPROPRIATE FEES BELOW. You can verify your membership status by calling the WAHPERD office at 608-785-8175 or 800-441-4568. You may obtain a membership application by clicking here.

COMPLETE ALL INFORMATION AND CHECK ALL APPROPRIATE FEES BELOW

Last Name: First Name:
Street:
City, State, Zip:
Phone (Home): Phone (Office):
E-mail Address:
Student Teacher Other
University or School District:

Is this your first WAHPERD convention? Yes    No
WAHPERD District (check one): NW     C     NE     SE     SC     SW     E
PRE-REGISTRATION  
CLASSIFICATION (Check all that apply) (must be received by 10/8) ON-SITE
Professional $70.00 $85.00
Student (Lunch included) $35.00 $45.00
Non-member $130.00 $140.00
One-day only - Professional $50.00 $60.00
Retired Free Free
Past President Free Free
Box Lunch (Thursday)   $15.00 each n/a
Awards Banquet (Thursday evening) @ $25.00 each n/a
Sponsor a student to awards banquet @ $25.00 each n/a
Total Enclosed: $

Pre-registration fees do not include awards banquet tickets. Awards banquet tickets must be purchased separately. No awards banquet tickets will be available for purchase on-site.

Banquet Preference (check one): 

 Grilled Chicken Breast Roasted Pork Loin Vegetarian Napoleon

Complete, print, and send this form along with a check for WAHPERD Convention Pre-Registration Fees to: WAHPERD, 24 Mitchell Hall, UW-La Crosse, La Crosse, WI 54601. Call 800-441-4568 or 608-785-8175 for more information.