December 14 Registration Fax to: (608) 204-9818 Mail to: 2830 Agriculture Dr.
              Madison, WI 53718

Personal Information
Full Name:
Title/Position:       Company/Affiliation:
Address:
City: State: Zip:
Phone: Fax: Email:

Schedule for the Day
AM Breakfast and Keynote 7:45 - 9:30 "Your'e Mission, If you Choose to Accept it..."
Workshop 9:45 - 11:45 "Matters of the Heart"
Registration Fees Registration for both sessions required for this special event
__ $55 GMA SHRM Members
__ $70 Non Member
__ $15 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, December 10, 2004.


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

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