Page 13 - Summer2018

WISE TRADITIONS 2018 REGISTRATION FORM

First Name Last Name Name for Badge
____________________________________________________________________________________________________________
Organization/Affiliation
____________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________
City State Zip Code Country
____________________________________________________________________________________________________________
Phone Fax r Check here if you are interested in donating food.
____________________________________________________________________________________________________________
E-mail Website r This is my first Wise Traditions conference.
____________________________________________________________________________________________________________
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 below.
MEMBERSHIP: become a member of the Foundation and receive a conference registration discount. CHAPTER LEADERS
r $40 US Annual Membership r $25 US Reduced (financial hardship) r $50 Canadian/International
r I am a chapter leader.
FULL REGISTRATION* includes conference materials, Friday sessions, lunch and dinner, Saturday sessions, r I plan to attend the Chapter Leader Meeting
lunch and Awards Banquet, Sunday sessions and brunch (except for no-meal option). Does not include Monday. Thursday, Nov 15, 10 am - 4 pm
By Sept 20 After Sept 20
r Full Registration Member $475 $525 How did you hear about the conference?
r Full Registration Non-Member $515 $565 r WAPF journal r WAPF email
r Full Registration Student/Senior Member $400 $450 r Friend/colleague r WAPF postcard
r Full Registration Student/Senior (62+) Non-Member $440 $490 r Blog r Twitter or FB
r Full Registration Adult with Child in Kid's Program $400 $450 r Web advertisement r WAPF website
r Full Registration No-Meal Option (meals not included) $350 $400 r Print advertisement r Radio
r Another conference r Chapter
*ADDITIONAL FEE: SATURDAY COOKING CLASS WITH SALLY FALLON MORELL r Other, please specify__________________
r Cooking Class - must be registered for full or Friday $30 $30
What is your current occupation?
WEEKEND REGISTRATION includes sessions with lunch and banquet on Saturday and lunch on Sunday. r Medical practitioner r Farmer
r Weekend Registration $330 $360 r Nutritionist r Homemaker
r Massage therapist r Student
DAILY REGISTRATION includes conference materials, sessions and lunch (no dinner). r Chiropractor r Retired
r Daily Registration r Friday* r Saturday r Sunday $145 $165
r Saturday Traditional Diets Seminar, Sally Fallon Morell $75 (limited to 200) $95 r Nurse r Teacher
r Monday Guided Farm Visit 7-6 (includes lunch) $115 $115 r Agriculture professional r Journalist
r Monday: r Julia Ross or r Chris Masterjohn $115 $115 r Artisan worker r Chef
r Other, please specify__________________
EVENING EVENTS
r Thursday Fundraiser Reception $75 $75 THREE WAYS TO REGISTER:
r Friday Dinner and Events $60 $60
r Saturday Evening Awards Banquet $85 $85 1. PHONE (540) 722-7104
2. FAX (540) 301-3536
Please select the sessions you plan to attend. This helps us plan but you can change your mind.
Friday seminar choice – r GAPS r Thyroid Health r Self Healing r Farming r Cooking Class (additional fee) 3. MAIL
WAPF Wise Traditions Conference
Saturday Choice – r Cancer r Nourishing Traditional Diets r Cooking/Practical r Wellness r Farming
Sunday Seminar Choice – r Gastrointestinal r Aging Gracefully r Toxic World r Dental r Cancer 1900 Jones Rd
Winchester, VA 22602
CHILDREN'S PROGRAM (Child must be age 3-12 and potty trained.) PLEASE NOTE:
______Child’s Name(s)______________________________________________________Age(s)______________
______@ $250 per child for Friday - Sunday includes Friday lunch & dinner, Saturday lunch, Sunday brunch One adult registration per form,
please. Forms submitted without
rGF/CF meals OR rGF only OR rCF only for ____ children OR ____@ $150 per child, includes no meals.
payment will not be processed.
CEUs FOR RNs & LACs. A $5 certificate of attendance is available. It suffices for RDs & nutritionists.
rRN rLAc – rAll 3 days $65 rFriday $25 rSaturday $25 rSunday $25// rRD or nutr. rCert of Attend. $5. FOR FURTHER INFORMATION
wisetraditions.org
registrar@ptfassociates.com
PAYMENT PROCESSING
Total Due:______________rMasterCard rVisa rCheck Payment/Money Order (make payable to WAPF)
Full Name ____________________________________________________________________________________ NO REFUNDS will be issued after
December 31, 2018.
Card Number__________________________________________________________________________________
Exp. Date_____________________________________Security Code (3 digits on back of card)_______________
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, 2018 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 Balitmore Hilton Hotel.
SUMMER 2018 Wise Traditions 11