April 17 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:

Recognition Night




4:30 - 5:00	Registration
4:30-7:00	Hors d’ oeuvres, cash bar and Table Top Displays
5:00 - 6:00	General Networking & Ice Breaker
6:00 - 7:00	Recognition

Registration Fees

____ Complimentary Registration

____ Sign me up for a table top display for $50

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, April 13, 2007.

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