Page 17 - Spring2013

WISE TRADITIONS 2013 REGISTRATION FORM

First Name Last Name Name for Badge
____________________________________________________________________________________________________________
Organization/Affiliation
____________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________
City State Zip Code Country
____________________________________________________________________________________________________________
Phone Fax
____________________________________________________________________________________________________________
E-mail Website rPlease check here if you are a member of WAPF
____________________________________________________________________________________________________________
r Check here to reserve Gluten & Casein free conference meals. OR r Gluten free only. OR r Casein free only. Register for GF and/or CF children's meals
MEMBERSHIP: become a member of the Foundation and receive our quarterly journal, full of informative
articles as well as sources of healthy food. WAPF members receive a conference registration discount. CHAPTER LEADERS
r$40 US Regular Annual Membership r$25 US Student or Senior (62+) r$50 Canadian/International rI am a chapter leader.
rI plan to attend the Chapter Leader Meeting
Full Conference Registration includes Conference Materials, Friday Sessions, Friday Lunch, Friday Dinner, Thursday, Nov 7, 10 am - 4 pm
Saturday Sessions, Saturday Lunch, Saturday Evening Awards Banquet, Sunday Sessions and Sunday Brunch
By Sept. 16 After Sept. 16 How did you hear about the conference?
rFull Registration Student/Senior Member $290. $340. rWAPF journal rWAPF email
rFull Registration Student/Senior Non-Member* $315. $365. rFriend/colleague rFlyer
rFull Registration Member $390. $440. rBlog rTwitter
rFull Registration Non-Member $430. $480. rWeb advertisement rFacebook

rDaily Registration Student/Senior Member* $120. $160. rPrint advertisement rRadio
rDaily Registration Student/Senior Non-Member* $145. $185. rAnother conference rChapter
rDaily Registration Member $170. $210. rOther, please specify__________________
rDaily Registration Non-Member $210. $250.
rFriday Dinner & Events $ 60. $ 85. What is your current occupation?
rSaturday Evening Awards Banquet $ 75. $100. rMedical Practitioner rFarmer
r Monday Posture and Movement (8-4, incudes lunch) $ 90. $100. rNutritionist rHomemaker
r Monday Farm Tour (8-4, includes lunch) $ 90. $100. rMassage Therapist rStudent
r Monday Raw Milk Series (8-4, includes lunch) $ 90. $100. rChiropractor rRetired
r Monday Homeopathy Workshop (8-4, includes lunch) $ 90. $100. rNurse rTeacher
r Monday WAPF Cooking (8-4, includes lunch) $ 90. $100. rAgriculture Professional rJournalist
* Student/Seniors must show ID. Senior is 62 and older.
rArtisan Worker rChef
If you are attending as a daily registrant, please indicate the day(s) you will be attending: rOther, please specify__________________
rFriday November 8 Registration includes Conference Materials, Friday Sessions and Friday Lunch PLEASE FAX OR MAIL THIS FORM TO:
rSaturday November 9 Registration includes Conference Materials, Saturday Joint Sessions and Saturday Lunch Fax: (304) 724-3007
rSunday November 10 Registration includes Conference Materials, Sunday Sessions and Sunday Brunch
Mail:
Friday Seminar Choice – please select one for planning purposes only, not binding. WAPF Wise Traditions Conference
rNourishing Traditional Diets rRadical Nutrition rSulfur in Disease rScience of Farming rCooking 159 Jenny Lind Drive
Saturday Choice – please select one for planning purposes only, not binding. Harpers Ferry, WV 25425
rMain General Session: Curing the Incurable rWellness Track rFarming & Gardening Contact:
Sunday Seminar Choice – please select one for planning purposes only, not binding. Conference Registration (304) 724-3006
rOur Toxic World rCancer rNative Ways rChronic Disease rMaking it Practical registrar@ptfassociates.com
or
Childcare (Child must be age 3-12 and potty trained) WAPF (202) 363-4394
______Child’s Name(s)_______________________________________________________________Age(s)_______ info@westonaprice.org
______@ $210 per child for Friday - Sunday includes Friday lunch & dinner, Saturday lunch, Sunday brunch Poster Presentations Info:
rGF/CF meals OR r GF only OR r CF only for ____ children OR ____@ $100 per child, includes no meals. info@westonaprice.org
Continuing Education Credits for RNs & LAcs. A $5 certificate of attendance is available. It suffices for RDs & nutritionists. PLEASE NOTE:
rRN rLAc - rAll 3 days $65 rFriday $25 rSaturday $25 rSunday $25//rRD or nutr.rCert of Attend. $5. One adult registration per form, please.
Payment Processing Forms submitted without payment
Total Due:______________rMasterCard rVisa rCheck Payment/Money Order (make payable to WAPF) will not be processed.
Full Name Security Code (3 digits on back of card)
NO REFUNDS will be issued after
_____________________________________________________________________________________________ December 31, 2013.
Card Number Expiration Date
_____________________________________________________________________________________________ FOR FURTHER INFORMATION visit
www.westonaprice.org/conference
By submitting this form, I authorize Wise Traditions to charge the applicable registration fees. I understand that all cancellations must be submitted in writing and must be received
by October 18, 2013 to be eligible for a refund, less a $25.00 administrative fee. All refunds will be issued following the conference. Substitutions will be permitted at any time.
Registration packets will not be mailed and must be picked up on-site at the conference registration desk at the Sheraton Atlanta Downtown Hotel.
Wise Traditions SPRING 2013 SPRING 2013 Wise Traditions 17