WACE 20TH WORLD CONFERENCE REGISTRATION FORM
       
    Registrant's E-Mail Address:
    Click here if you DO NOT want your email address
to be listed on the Participants Roster:
Do Not Use
    Is This Your First WACE Event?:
Please make a selection.
    How did you learn of this WACE event?
       
    Honorific
    Last Name:
    First Name:
    Name to Appear on Conference Badge:
(If difference from above)
    Job Title/ Designation:
    University / Organization:
    Mailing Address:
     
    City:
    State / Province:
    Country:
    Postal Code:
    Telephone Number:
    Fax Number:
    Please indicate any dietary requirements here:
     
    Registration (Choose from menu):
    WACE Global Partner: $450.00 USD
WACE Member: $550.00 USD
Non-WACE Member: $690.00 USD
Host Country Thailand Delegate: $200.00 USD
ASEAN Delegate: $200.00 USD
  $ USD
    Other Registration Types (Choose from menu):
    Student Delegate: $100.00 USD   $ USD
    Guest: $250.00 USD   $ USD
    (Includes: opening reception, three luncheons, morning & afternoon teas and closing reception & awards banquet.)
   
    If yes, please provide the Name(s) for each Guest
on this registration form:
   
           
    Please indicate any dietary requirements for each Guest:    
    Please include the Guest’s payment with your payment.    
    TOTAL CONFERENCE CHARGES:   $ USD
     
    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)
Please make a selection.
       
    Credit Card Number (MasterCard or Visa Only):
    Expiration Date (mm/yyyy):
    Name on Card:
       
   

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

       
    Cancellation Policy
Cancellation fee $50 USD prior to May 1, 2017.
No refund after May 1, 2017.
There will be a $50 USD charge for all returned checks.

Registrations without payment will not be processed until payment is received.