North Central Regional Meeting

Meeting Location:

Jensen Community Center
487 N. Main Street
Amherst, WI 54406

Member: $50
Non-Member: $80
Vendor: $70

*A 3.5% processig fee will be added to credit card payments.

How many people are you registering? *

(including yourself)

Regional Meeting Registration Info

First Name *

Last Name *

Email Address *

Phone

Current Employer *

Job Title

DNR has implemented a new CEC tracking system. This requires WWOA report credit hours by operator certification number.

DNR Operator Certification #

Event Fee(s)

If you have a discount code, enter it here

Registration Fee(s) *

Individual Attendee - $ 80.00

Vendor Table - $ 70.00

Credit Card Process Fee

Total for this participant

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *