Annual Conference Registration

Please fill out the form below and click "Submit" to go to the Payments Options Page. All fields with an * are required.

First Name: *
Last Name: *
Title:
Company: *
Address: *
City *
State: *
Zip: *
Phone: *
Fax:
Email: *
Is your company a member of RSA-Wisconsin? *	Yes No
Please select one course number for each time period:
Wed. 3:00pm - 6:00pm (Optional)
Thu. 8:00 am - 10:00 am	Opening
Thu. 11:00am - 12:30pm
Thu. 2:00pm - 3:30pm
Thu. 3:45pm - 4:45pm
Fri. 8:00am - 9:00am
Fri. 9:15am - 10:15am
Fri. 10:30am - 11:30am
Fri. 12:30pm - 3:30pm	Closing
Please select which items you will be attending
Legislative Committee Meeting
Board Meeting
Wed. Pre-Con Session
Wed. Reception (Decision Makers Only)
Thu. Networking Buffet (Everyone invited)
Thu. Comedy Show (Everyone invited)
Save 50% off your FIRST year's dues! Become a regular member for the first time and save half of your first year membership dues if you sign up when you register for the conference.
Total number of individuals served (agency-wide)
x $17.50
=
	CBRF RCAC AFH Day Care Other