WACE 21ST WORLD CONFERENCE REGISTRATION FORM
 
Registrant's E-Mail Address:
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to be listed on the Participants Roster:
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Is This Your First WACE Event?:
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Honorific
First Name:
Last Name:
Job Title/ Designation:
University / Organization:
Mailing Address:
 
City:
State / Province:
Country:
Postal Code:
Telephone Number:
Please indicate any dietary requirements here:
 
Registration (Choose from menu):
WACE Global Partner: $400.00 USD *
WACE Member: $580.00 USD
Non-WACE Member: $690.00 USD
CEIA Member: $450.00 USD
University of Cincinnati: $290 USD *		   $ USD
* (after the Global Partnership complimentary registrations for these categories have been used)
Other Registration Types (Choose from menu):
Employer Delegate: $250.00 USD
Student Delegate: $240.00 USD		   $ USD
Guest: $200.00 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)
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Credit Card Number (MasterCard or Visa Only): - - -
Expiration Date (mm/yyyy):
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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
   
Registrations without payment will not be confirmed until payment is arranged.