IGWA E. Idaho Workshop Registration
Friday, March 19, 2010 AmeriTel Inn - Pocatello, ID
Two ways to register:
1. Print a registration form and mail or fax to IGWA office
2. Complete the online registration below with credit card information
Participant Information
Name
Organization
Mailing Address
City/State/Zip
Home Phone
Work Phone
Email Address
Workshop Fees
(as of Saturday, March 13, an additional $50 late fee was added)
Member Registration for E. Idaho Workshop (full day)
$140.00
Non-Member Registration for E. Idaho Workshop (full day)
$180.00
Member Registration for E. Idaho Workshop (half day)
$100.00
Non-Member Registration for E. Idaho Workshop (half day)
$120.00
Payment Information
Credit Card Type
Please select one... Visa Mastercard Discover American Express
Credit Card Number
Expiration Date
CRV (Security Code on card)
Name on Card
By entering your name here, you authorize us to process your credit card for the above-indicated amount
