WSDLA Roundtable Retreat Registration

WSDLA Roundtable Retreat
Friday October 19, 2018
Tulalip Resort Casino, Tulalip, WA

* Required Fields

First Name: *
Last Name: *
Credentials: *
Lab or Company Name: *
Mailing Address: *
City: *
State: *
Zip Code: *
Telephone: *
Fax
Email Address: *

ADA Special Accommodations Any special accommodation requests must be received in writing at the WSDLA Office by September 28, 2018.
Enter your Special Accommodation Request Here...

Registration Fees (Must be a member of WSDLA or other state association or lab owner or manager.)
Full Registration - $275 (Pre-registration); $300 (Onsite Registration) (Includes all events and continuing education. Spouses/Guests may attend the Networking Reception complimentary.) Total Due: $275

Credit Card Authorization
Name on Card: *
Card Type: *
Card Number: *
Expiration Date: *	/
Security Code: * (Vi/MC users: 3 digit number on back of card; AMEX users: 4 digit number on front of card)

Credit Card Billing Address
Same as mailing address above.
Address: *
City: *
State: *
Zip Code: *

CANCELLATIONS: Refund requests received prior to October 10, 2018 will be given a refund less a $25 administrative fee. No refunds will be given after October 10, 2018. You may switch registration to another attendee from your office.
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