Printable Registration form for the
WEDA 2005 Governor's Conference on Economic Development

(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:

__ Legislative Day on February 2
__ Luncheon on February 3
__ Reception on February 3
__ Breakfast on February 4

REGISTRATION FEES
Check payable to WEDA.
__ $175 on or before January 31
__ $225 after January 31
__ $250 at the Door

To cancel your registration, send a written request by Jan. 23 to WEDA, Attn: WEDA Governor's Conference 2005, 4600 American Parkway, Ste 208, Madison, WI 53718 or fax it to 608-241-7790. A $50 handling fee is not refundable. No refunds will be given after Jan. 23. 2005

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)


Blocks of rooms have been set aside at the following hotels:

Hilton Monona Terrace, 9 E. Wilson St., Madison (this block of rooms will be held until Jan. 2). There is a special rate of $119 single / $119 double, plus tax, for the event. To make a reservation, call 800-445-8667 and please identify yourself as a conference participant.

For directions and maps, please visit the Hilton Hotel's website at www.hilton.com or call the hotel at 800-445-8667.

Concourse Hotel, 1 W. Dayton St., Madison (this block of rooms will be held until Jan. 4). There is a special rate of $92 single / $102 double, plus tax, for the event. Governor's Club rooms are available for $125 / $135, plus tax. To make a reservation, call 608-257-6000 or 800-356-8293 and identify yourself as a conference participant.

For directions and maps, please visit the Concourse Hotels web site at www.concoursehotel.com or call the hotel at 800-356-8293.

Best Western, Inn on the Park, 22 S. Carroll St., Madison (this block of rooms will be held until Jan. 14). there is a special rate of $79 single / $79 double, plus tax, for the event. To make a reservation, call 800-279-8811 and please identify yourself as a conference participant.

For directions and maps, please visit the Best Western web site at www.bestwestern.com or call the hotel at 800-780-7234.