Page 28 - Fall2012

WiSE tRAditionS 2012 REGiStRAtion FoRm

First Name Last Name Name for Badge
____________________________________________________________________________________________________________
Organization/Affiliation
____________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________________
City State Zip Code Country
____________________________________________________________________________________________________________
Phone Fax
____________________________________________________________________________________________________________
E-mail rPlease check here if you are a member of WAPF
____________________________________________________________________________________________________________
r Check here to reserve GF/CF conference meals. OR r Check here to reserve GF only meals. OR r Check here to reserve CF only meals. A separate GF/CF
buffet is provided at all meals, except the banquet where you'll receive the GF/CF plate with a special dinner ticket. Register for GF/CF children's meals below.
Full conference Registration includes conference materials, Friday Sessions, Friday Lunch, Friday dinner, cHAPtER LEAdERS
Saturday Sessions, Saturday Lunch, Saturday Evening Awards Banquet, Sunday Sessions and Sunday Brunch rPlease check here if you are a chapter leader.
By October 15 After October 15 rI plan to attend the Chapter Leader Meeting
rFull Registration Student/Senior Member* $290. $340. NOTE NEW DAY: Thursday, Nov 8, 10-4
rFull Registration Student/Senior Non-Member* $315. $365.
rFull Registration Member $390. $440.
rFull Registration Non-Member $430. $480. What is your current occupation?
rMedical Practitioner rFarmer
rDaily Registration Student/Senior Member* $120. $160.
rDaily Registration Student/Senior Non-Member* $145. $185. rNutritionist rHomemaker
rDaily Registration Member $170. $210. rMassage Therapist rStudent
rDaily Registration Non-Member $210. $250. rChiropractor rRetired
rFriday Dinner & Events $ 60. $ 85. rNurse rTeacher
rSaturday Evening Awards Banquet $ 75. $100. rAgriculture Professional rJournalist
r Monday Posture and Movement (8-4, incudes lunch) $ 75. $ 85. rArtisan Worker rChef
r Monday Farm Tour (8-4, includes lunch) $ 75. $ 85. rOther, please specify__________________
r Monday Nutrition Topics (8-4, includes lunch) $ 75. $ 85.
r Monday Seven Days of Dinner (8-4, includes lunch) $ 75. $ 85.
* Student/Seniors must show ID. Senior is 62 and older.
PLEASE coPY tHiS PAGE And
r Thursday, November 8 FTCLDF FundRAISER Dinner/Dance $ 75. $ 95. FAX oR mAiL it to:
r Thursday, November 8 FTCLDF FundRAISER Child Price $ 45. $ 45.
Fax:
if you are attending as a daily registrant, please indicate the day(s) you will be attending: WAPF Wise Traditions Conference
rFriday November 9 Registration includes Conference Materials, Friday Sessions and Friday Lunch (304) 724-3007
rSaturday November 10 Registration includes Conference Materials, Saturday Joint Sessions and Saturday Lunch
rSunday November 11 Registration includes Conference Materials, Sunday Sessions and Sunday Brunch mail:
WAPF Wise Traditions Conference
Friday Seminar choice – please select one for planning purposes only, not binding. 159 Jenny Lind Drive
rTraditional Diets rGut & Psychology rNutrition & Behavior rScience of Farming rCooking Harpers Ferry, WV 25425

Saturday choice – please select one for planning purposes only, not binding. contact:
rMain General Session: Nutrition & Behavior rWellness Track rScience of Farming Conference Registration (304) 724-3006
Sunday Seminar choice – please select one for planning purposes only, not binding. registrar@ptfassociates.com
rFrontiers of Science rNutrition & Behavior rNative Ways rWise Entrepreneurs rNutrition or
WAPF (202) 363-4394
childcare (child must be age 3-12 and potty trained) info@westonaprice.org
______Child’s Name(s)_______________________________________________________________Age(s)_______
______@ $210 per child for Friday - Sunday includes Friday lunch & dinner, Saturday lunch, Sunday brunch Poster Presentations Info:
rGF/CF meals OR r GF only OR r CF only for ____ children OR ____@ $100 per child, includes no meals. info@westonaprice.org
continuing Education credits
LAcs, RNs. Sorry, we are not offering CEUs for other professions. A certificate of attendance suffices for RDs and nutritionists.
rFriday, $25. rSaturday, $25. rSunday, $25. rAll 3 days, $65. rCert of Attendance/nonCEU $5. PLEASE notE
Payment Processing one adult registration per form, please.
Total Due:______________rMasterCard rVisa rCheck Payment/Money Order (make payable to WAPF) Forms submitted without payment
will not be processed.
Full Name Security Code (3 digits on back of card)
_____________________________________________________________________________________________ NO REFUNDS will be issued after
Card Number Expiration Date December 31, 2012.
_____________________________________________________________________________________________
By submitting this form, I authorize Wise Traditions to charge the applicable registration fees. I understand that all cancellations FoR FURtHER inFoRmAtion visit
must be submitted in writing and must be received by October 19, 2012 to be eligible for a refund, less a $25.00 administrative
fee. All refunds will be issued following the conference. Substitutions will be permitted at any time. Registration packets will not www.westonaprice.org/conference
be mailed and must be picked up on-site at the conference registration desk at the Santa Clara Convention Center.
28 Wise Traditions FALL 2012 FALL 2012 Wise Traditions

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