Page 17 - Summer 2019 Journal

WISE TRADITIONS 2019 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.
DISCOUNTED MEMBERSHIP: become a member of the Foundation while registering and receive a discount.
r$30 US Annual Membership (regularly $40) r$40 Canadian/International (regularly $50)
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 Friday, Nov 15, 9 am-1:30 pm ($20 discount)
How did you hear about the conference?
rFull Registration
rFull Registration No-Meal Option (meals not included)
By Sept 20
$425 $350
After Sept 20
$450 $400
rWAPF email rWAPF postcard rTwitter or FB rWAPF website r Radio
WEEKEND REGISTRATION includes sessions with lunch and banquet on Saturday and lunch on Sunday. rWeekend Registration $315 $355
DAILY REGISTRATION includes conference materials, sessions and lunch (no dinner).
r WAPF journal
r Friend/colleague
r Blog
r Web advertisement
r Print advertisement
r Another conference
rOther, please specify__________________
rDaily Registration rFriday* rSaturday rSunday r Saturday Traditional Diets Seminar, Sally Fallon Morell r Monday Guided Farm Visit 7 AM-6 PM (includes lunch)
EVENING EVENTS
rThursday Fundraiser Reception rFriday Dinner and Events rSaturday Evening Awards Banquet
FTCLDF BREAKFAST
rOne breakfast (donation) rBreakfast for Friday, Saturday, Sunday
CHAPTER LEADER MEETING
r$20 discount for chapter leaders attending Friday's meeting.
$135 $160 $75
$110
r Chapter What is your current occupation?
$50 $60 $75
$17 $45
-$20
r Medical practitioner r Nutritionist
r Massage therapist r Chiropractor
r Farmer
r Homemaker r Student
r Retired rTeacher
r Journalist
r Chef
r Nurse
r Agriculture professional
r Artisan worker
rOther, please specify__________________
Please select the sessions you plan to attend. This helps us plan but you can change your mind.
Friday Seminar Choice – AM:rGAPSrEstrogen PM:rCooking rHolland/Quinn rCampbell/Weeks Friday Evening Choice –rSustainability Requires Ruminants rPractitioners Panel rPractical Panel rFilm Saturday Choice –rSeneff/Cowan rNourishing Traditional Diets rPractical rEstrogen/Vitamin A/etc. Sunday Seminar Choice – rPractical rTennant rIron/Bacteria/Cholesterol rHomeopathy/Int. Fasting
CHILDREN'S PROGRAM (Child must be age 3-12 and potty trained.)
______Child’s Name(s)______________________________________________________Age(s)______________ ______@ $250 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 Road
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, 2019.
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 23, 2019 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 when you arrive at the conference.