WIPWM - Conference Registration
PURCHASER INFO
Name
Title
Organization
Address
City
State
Zip
Phone
Fax
Email
If you use Paypal with a different email, please provide that too:
PayPal Email
ATTENDEE/MEMBER INFO (ONLY IF DIFFERENT FROM ABOVE)
Name
Title
Organization
Address
City
State
Zip
Phone
Fax
Email
ITEMS PURCHASING
Regular Registration
$0
Members $110
Non-Members $140
For Members, please let us know which organization you are a member:
Women in Philanthropy of W Mass
Bay Path College Student
Womens Fund of W Mass
Community Foundation of W Mass
AFP of W Mass
Lunch Only Option
$0
$40
(ONLY if not already attending the full conference)
Sponsor/Exhibitor
$0
$2,000 Grantee Sponsor
$1,000 Presenting Sponsor
$500 Workshop Sponsor
$500 Lunch Table Sponsor
$250 Exhibitor
Payment Method
- please select -
Credit Card via PayPal
Check
WORKSHOP OPTIONS
Will you join us for breakfast?
- please select -
Yes
No
Session I (8:45am-10:00am)
- please select -
A-1
A-2
A-3
A-4
A-5
Session II (10:20am-11:50am)
- please select -
B-1
B-2
B-3
B-4
B-5
Will you join us for lunch?
- please select -
Yes
No
Session III (1:50pm-3:50pm)
- please select -
Yes
No
(Asking Workshop)
Dietary Restrictions?
Other comment?