November 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:



8:00-8:30	Registration and Breakfast
8:30-12:00	Diversity Works Conference

Registration Fees

Continental Breakfast and Program

__ $35 GMA SHRM Member - All attendees pay member rate for this event

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 12, 2008.

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