2007 Midwest Regional Conference Registration Form

2007 Midwest Regional Conference

Registration form (for snail-mail)

To register, please fill out the form below, print it, place it in an envelope along with your check made out to MWAC and mail it to:

MN Wildlife Assistance Cooperative

C/O Jeff Tyson

1121 Grouse St.

Sandstone, MN 55072

If you rather register and pay online using paypal click here: Online Conference Registration Form


	Conference Fees (includes all meals and lodging)
	check all that apply
	MWAC Member	$220.
	Non-Member	$245.
	Student (must bring proof of student status)	$210.
	Become an MWAC member*	$20.
	BREW pre-conference seminar	$40.
	If registering after Oct. 15, 2007, late fee	$10.
	* will apply to current conference registration
	Total:

First name M.I. Last name

Street address

City State Zip code

Phone Mobile Email

Organization Affiliations:

Arrival date: Approximate arrival time:

Dinning preferences: Vegetarian Meat

Roomate preferences: