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 and Breakfast	8:00-9:00
Networking and Breakfast	8:30-9:00
Program	9:00-12:00

Registration Fees

Full Program

__ $45 GMA SHRM Member

__ $55 Non Member

__ $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, January 12, 2006.

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