Registration Form w/ Check

2023 Conference Registration & Check Payment

Registration – Deadline is 4/25/2023

To Register for the Conference and pay with a check, you must complete the registration form below for each individual attending. Payment may be mailed into the address below. Click here to Register & pay with a credit card. Be sure to include payment for additional meals requested for non-registered guests. Fees are non-refundable for no-shows unless cancelled by Tuesday, April 25, 2023.

Checks Payable and Mail To:

WHSFMA Conference
Cathy Swenson, Treasurer
Jefferson County DHS
1541 W Annex Rd,
Jefferson, WI 53549

Registration Questions/Concerns/Changes:

Cathy Swenson
Phone: 920-728-1853
FAX: 920-674-2359
CathyS@jeffersoncountywi.gov

Fill out our WHSFMA Conference Registration Form below and pay with a check.

"*" indicates required fields

County*

Agency Name*

Name*

First Last

Job Title*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Extension

Choose a Group

Registration Fees (includes all breaks/meals for the day you register):

Full Conference – Tuesday, Wednesday, Thursday - $225

Two-Day Conference – Tuesday & Wednesday - $190

Two-Day Conference – Wednesday & Thursday - $190

Add-On Meal Rates (for non-registered conference guests only)

Banquet – Tuesday Evening

Breakfast – Wednesday

Lunch – Wednesday

Breakfast – Thursday

Total

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