Page 13 - Summer 2017 Journal

WISE TRADITIONS 2017 REGISTRATION FORM
First Name Last Name Name for Badge ____________________________________________________________________________________________________________
Organization/Affiliation ____________________________________________________________________________________________________________
Address ____________________________________________________________________________________________________________
City State Zip Code Country ____________________________________________________________________________________________________________ Phone Fax rCheck here if you are interested in donating food. ____________________________________________________________________________________________________________ E-mail Website rThis is my first Wise Traditions conference. ____________________________________________________________________________________________________________ rCheck here to reserve Gluten & Casein free conference meals. ORrGluten free only. ORrCasein free only. Register for GF and/or CF children's meals below.
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. r$40 US Annual Membership r$25 US Reduced (financial hardship) r$50 Canadian/International
FULL REGISTRATION includes conference materials, Friday sessions, lunch and dinner, Saturday sessions, lunch and Awards Banquet, Sunday sessions and brunch (*except for no-meal option). Does not include Monday.
CHAPTER LEADERS
rI am a chapter leader.
r I plan to attend the Chapter Leader Meeting Thursday, Nov 9, 10 am - 4 pm
How did you hear about the conference?
rFull Registration Member
rFull Registration Non-Member
rFull Registration Student/Senior Member
rFull Registration Student/Senior (62+) Non-Member
r Full Registration Adult with Child in Kid's Program
r Full Registration No-Meal Option (meals not included*)
rWAPF journal
r Friend/colleague
r Blog
rWeb advertisement
rPrint advertisement
rAnother conference
rOther, please specify__________________
WEEKEND REGISTRATION includes sessions with lunch and banquet on Saturday and lunch on Sunday. rWeekend Registration $300 $330
DAILY REGISTRATION includes conference materials, sessions and lunch (no dinner).
r Chapter What is your current occupation?
rDaily Registration rFriday rSaturday rSunday r Saturday Traditional Diets Seminar, Sally Fallon Morell
r Monday Guided Farm Visit 7-6 (includes lunch) rMonday WAPF Cooking 9-4 (includes lunch) rMonday Chris Masterjohn Seminar
EVENING EVENTS
rFriday Dinner and Events rSaturday Evening Awards Banquet
$130 $150 $60 (limited to 200)
$100 $100 $100 $100 $100 $100
$60 $60 $75 $75
rMedical practitioner r Nutritionist rMassage therapist r Chiropractor
r Farmer
r Homemaker r Student
r Retired
r Teacher
r Journalist
r Chef
Please select the sessions you plan to attend. This helps us plan but you can change your mind.
Friday seminar choice –rGAPS rThyroid Health rAdrenal rFarming
Saturday Choice –rHormone Health rNourishing Traditional Diets rCooking/Practical rWellness Sunday Seminar Choice – rMind and Eyes rDiet, Exercise, Diabetes rFertility/Children rCooking/Gardening/Practical
CHILDREN'S PROGRAM (Child must be age 3-12 and potty trained.)
______Child’s Name(s)______________________________________________________Age(s)______________ ______@ $225 per child for Friday - Sunday includes Friday lunch & dinner, Saturday lunch, Sunday brunch rGF/CF meals OR rGF only OR rCF only for ____ children OR ____@ $150 per child, includes no meals.
CEUS FOR RNS & LACS. A $5 certificate of attendance is available. It suffices for RDs & nutritionists. rRNrLAc –rAll 3 days $65rFriday $25rSaturday $25rSunday $25//rRD or nutr.rCert of Attend. $5.
PAYMENT PROCESSING
Total Due:______________rMasterCard rVisa rCheck Payment/Money Order (make payable to WAPF) Full Name ____________________________________________________________________________________ Card Number__________________________________________________________________________________ Exp. Date_____________________________________Security Code (3 digits on back of card)_______________
THREE WAYS TO REGISTER: 1. PHONE (540) 722-7104 2. FAX (540) 301-3536
3. MAIL
WAPF Wise Traditions Conference 1900 Jones Rd
Winchester, VA 22602
PLEASE NOTE:
One adult registration per form, please. Forms submitted without payment will not be processed.
FOR FURTHER INFORMATION
wisetraditions.org registrar@ptfassociates.com
NO REFUNDS will be issued after December 31, 2017
By Sept 17
$440
$480
$340
$365
$340
$300
After Sept 17
$490
$530
$390
$415
$390
$350
rWAPF email rWAPF postcard rTwitter or FB rWAPF website r Radio
r Nurse
rAgriculture professional
rArtisan worker
rOther, please specify__________________
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 20, 2017 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 Hyatt Regency Minneapolis Hotel.
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