IndianaWEA.org

2008 Spring Seminar

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Complete Detailed Information Below

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Please Choose One:
Morning Session Afternoon Session

Company:

*First Name: Middle Initial:

*Last Name:

*Address:

*City: *State: *Zip Code:

*Phone Number:

Email Address:

Certification Number:

Grade/Class: Expiration Date:

Member ($30)
Non-Member ($55- includes IWEA-only Membership)
Non-Member ($95- includes IWEA & WEF Membership)

Note: Make checks payable to: IWEA. Payments must be received with registration. Purchase Orders are accepted only from municipalities and government agencies (Please note purchase order above). Only registrations with Purchase Order # will be accepted by fax at (317)328-2545.