October 18 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	8:00-8:30
Morning Keynote and Breakfast	8:30-9:30	My Goldfish Died, Can I Take FMLA?
Morning Workshop	9:45-12:00	Swimming in the FMLA, Worker's Compensation and the ADA: Lifesaving Approaches for Your HR Department's Bermuda Triangle

Registration Fees

FMLA Presentations Only
__ $35 GMA SHRM Member
__ $45 Non Member
__ $10 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, October 14, 2005.

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