Printable Registration form for the
WEDA 2005 Fall Conference

(Please print and mail with check payable to WEDA.)

NAME___________________________________________________________

TITLE____________________________________________________________

ORGANIZATION___________________________________________________

ADDRESS________________________________________________________

CITY/STATE___________________________________ZIP________________

PHONE_____________________________

FAX_______________________________

E-mail____________________________

WEDA Member __ Yes __ No   __ Please send membership information.

Please complete the following information to help us accommodate all participants. Yes, I will attend the:

__ Tuesday Reception
__ Wednesday Breakfast
__ Wednesday Lunch Buffet
__ Wednesday Reception
__ Thursday Breakfast Buffet
__ Tour of Roundy’s Facility

REGISTRATION FEES
Check payable to WEDA.
__ Member: $175 ($150 before August 29)
__ Non-Member: $225 ($195 before August 29)

To cancel your registration, send a written request by September 15, 2005 to WEDA, 4600 American Parkway, Ste 208, Madison, WI 53718 or fax it to 608-241-7790 Attention: Julie Roelke

Payment Info:
VISA __ M/C __ Check Enclosed __ Please make your check payable to the Wisconsin Economic Development Association (WEDA)

Card # ________________________________________ Expiration _________________

Cardholder _______________________________________________________________

Signature ________________________________________________________________

Mail To:

WEDA
4600 American Parkway, Ste 208
Madison, WI 53718
Fax: (608) 241-7790 (For Credit Card Registrants Only)


A block of rooms has been reserved at the Olympia Resort & Conference Center. 262.369.4999, and ask for the WEDA rate of $99.00, available until August 22, 2005.