WACE PLANNING 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
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  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:
     
  DOMESTIC Current Anticipated A priority for
planning at the Institute
         
  Internships
Priority for Planning
  Cooperative Education or Sandwich Placements
Priority for Planning
  Work-Integrated Learning Placements
Priority for Planning
  Work-Integrated Learning Simulations, & Other Non-placement WIL
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 at the Institute
         
  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 WIL / Coop etc Exchanges
Priority for Planning
  Other (Please Describe)  
 
  WACE PLANNING INSTITUTE TUITION
  Registration Deadline: October 7, 2016

Regular Registration Fee: $725.00
2 or more from same institution: $650.00 per person
Early registration fee (by 9/14/16): $625.00

   
 
  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:
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:
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