Webinar Registration Members - Wisconsin Healthcare Engineering Association

Registration and Fees:*
- $300.00 - WHEA MEMBER - 2024 Webinar Subscription Series
Name*
First Last
Title*
Email*
Organization*
WHEA Chapter*
If you have actually paid dues to a Chapter, please pick which chapter here. If you have not, pick "Not a WHEA Member"
Address*
Street Address City State Zip
Work Phone*
See the phone format needed. Do not put a "1" before your phone number.
Representation*
Please identify the type of facility or industry and field you represent:
Please Specify Other:*
Payment Option*
Please provide P.O. Number:*
Gift Certificate #
Comments
Indicate special needs that you might want us to know about. ( i.e handicap access, Food Allergies, etc)
Total
$0.00
If payment is to be made by Check or P.O. number, return a copy of your invoice page with check payable to WHEA and mail to:

Wisconsin Healthcare Engineering Association
Jane Bruvold, Administrative Assistant
P.O. Box 1782
Appleton, WI 54912

Telephone: 920.570.4081

info@whea.com
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Note: See registration flyer for further information on cancellation rules and cancellation fees. All registration fees must be paid in advance.