WACE INSTITUTE REGISTRATION
  Each Registrant Must Fill Out Individual Form for Submission

(For Multiple Institutional Registrations, Payment May be Made As Single Payment for All Registrations
For Information please Contact Marty Ford)
     
  Primary Contact E-Mail Address:
     
  Click here if you DO NOT want your email address to
be listed on the Participants Roster for the Institute
Do Not Use
     
  Is this your first WACE Event?
No
  How did you learn about this WACE event?
     
  Primary Contact Full Name:
  Primary Contact Title:
  Institution Name:
  Institution Mailing Address:
   
  City:
  State / Province:
  Country:
  Postal Code:
  Telephone Number:
     
  DISCUSSION TOPICS  
   
  The Institute for Experiential Education features seven concurrent round table discussion topics. Please indicate which topic(s) in which are you interested:
   
Service Learning
Initiating New Programs
Co-Curricular Programs
 
     
    Current Anticipated A priority for
planning at Institute
DOMESTIC or INTERNATIONAL
         
  Internships
Priority for Planning
  Cooperative Education
Priority for Planning
  Work-Integrated Learning Placements
Priority for Planning
  Service-Learning / Community Service
Priority for Planning
  Undergraduate Research
Priority for Planning
  Project / Problem-based Learning
Priority for Planning
  Study Abroad
Priority for Planning
   
  WACE INSTITUTE REGISTRATION FEES
  Registration Deadline: October 2, 2017

Single Non-Member Rate: $775.00
WACE Member Registration Rate: $700.00
2 or more from same institution: $650.00 per person
Early Registration Rate (by 9/4/17): $600.00

   
 
  Total: $ USD
 
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 (Exactly as on CC):
   
 

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

If Paying by Check Send Registration Form and Payment to:
WACE
Suite 503
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