WACE CAO COLLOQUIUM REGISTRATION
     
  E-Mail Address:
     
  Please select here if this is your first WACE event:
     
  Honorific:
  Name:
  Position:
  Institution Name:
  Institution Mailing Address:
   
  City:
  State / Province:
  Country:
  Postal Code:
  Telephone Number:
     
  DOMESTIC Current Anticipated A Priority for Planning
         
  Internships
Priority for Planning
  Cooperative Education
Priority for Planning
  Work-Integrated Learning Simulations
Priority for Planning
  Service-Learning / Community Service
Priority for Planning
  Undergraduate Research
Priority for Planning
  Community-based Research
Priority for Planning
  Project / Problem-based Learning
Priority for Planning
  Other (Please Describe)
 
     
  INTERNATIONAL Current Anticipated A Priority for Planning
         
  Global Partnerships
Priority for Planning
  Study Abroad
Priority for Planning
  International SL / Community Service
Priority for Planning
  International Internships
Priority for Planning
  International Cooperative Education
Priority for Planning
  International Exchanges
Priority for Planning
  Other (Please Describe)  
 
  REGISTRATION FEE
  COLLOQUIUM REGISTRATION FEE (per person): $225.00
  (fee includes light breakfast, all breaks, luncheon and champagne reception)
   
  PAYMENT METHOD
  (ATTENTION: Payment by Credit Card REQUIRES ALL BILLING ADDRESS INFORMATION TO BE COMPLETED!)
   
  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 Mailing Address)
   
  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:
WACE
Suite 125
600 Suffolk Street
Lowell, MA 01854
USA
Attn: Marty Ford, WACE Director of Global Partnerships & Programs

Please make checks payable to: WACE

For Bank Transfer, please contact the WACE Secretariat for our banking information at
Marty_Ford@uml.edu

   
  Should you have any questions, please contact Marty at Marty_Ford@uml.edu