November 15 Registration

Fax to: (608) 204-9818

Mail to: 2830 Agriculture Dr.
Madison, WI 53718

Full Name:

Title/Position:

Company/Affiliation:

Address:

City:		State:	Zip:
Phone:		Fax:	Email:

Registration	8:30-9:00
Morning Presentation	9:00-11:30	*Panel Discussion and Breakouts*
Lunch & Announcements	11:45-12:30
Keynote	12:30 - 1:15	Keynote "Look Before Crossing: The Intersection of Personal and Orginazational Change"

Registration Fees

Morning Presentation Only	Lunch & Keynote Only	All Sessions
__ $35 ASTD/ISPI/GMA SHRM Member	__ $30 ASTD/ISPI/GMA SHRM Member	__ $55 ASTD/ISPI/GMA SHRM Member
__ $40 Non Member	__ $40 Non Member	__ $70 Non Member
__ $10 Students	__ $10 Students	__ $20 Students

Method of Payment - Pre-payment required for non GMA SHRM members.
Total to be charged: _________ Mastercard Visa Credit Card Number: Exp. Date:
Three digit verification number (on back of credit card):

Name as it appears on card:
Billing Address for Credit Card:

Please contact the GMA SHRM office if special assistance or meal requirements are needed.
No refund will be given for cancellations after noon on Friday, November 11, 2005.

GMASHRM Headquarters
2830 Agriculture Dr. :: Madison, WI 53718 :: Phone: (608) 204-9814 :: Fax: (608) 204-9818 :: Email: chapteradmin@gmashrm.org