REGISTRATION FORM

"Charting the Course" Wisconsin ESOP Chapter Conference

March 12, 2013

Bridgewood Best Western Resort & Conference Center

100 Cameron Way, Neenah, WI 54956

920-720-800 . http://www.bridgewoodresorthotel.com/

  On or Before February 26, 2013  After February 26, 2013
Members:  $75 per person (1st & 2nd registrant)
$65 per person (3rd or more registrants)
$90 per person (1st & 2nd registrant)
$80 per person (3rd or more registrants)
     
Non Members:  $120 per person  
     
At The Door: $140 per person  
Cancellation Deadline: March 1, 2013.
You may send a substitute from your company at no additional charge.
To register and pay via check please complete this form and mail to: Donna Walseth - 906 97th Lane NE - Blaine, MN 55434 - dwalseth@esopexec.org
763-785-4122 (phone) - 763-785-4168 (fax)
*Please Indicate Number of Persons for Each Registration Category.

Members:
Non Members:

Total number of Registrants : Total:

Registrant 1

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Registrant 2

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Registrant 3

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Registrant 4

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Registrant 5

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Registrant 6

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Registrant 7

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Registrant 9

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Registrant 10

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Company Information

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Order Total:

* Name On Credit Card:  
Credit Card:
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Expiration Date:


Your credit card will be charged the amount of : .



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‡ The maximum amount of registants per request is 10.

Cancellation Policy

Cancellation Deadline: March 1, 2013

Hotel Information

Bridgewood Best Western Resort & Conference Center

100 Cameron Way . Neenah, WI 54956

920-720-800 - http://www.bridgewoodresorthotel.com/