At this point, please go to the file menu on your browser and click on "print" to print this registration form. You must print this form before you click on the "done" button below. Once you have printed this form, then you must click on the "done" button below.
Please mail your printed registration form, along with the payment for your total registration fee ($180 per facility), to LeadingAge Wisconsin, 204 South Hamilton Street, Madison WI 53703. Please make all checks payable to LeadingAge Wisconsin.
If you prefer to pay by credit card, please fax a copy of this registration form to 608-255-7064, or e-mail (info@leadingagewi.org), and then call the LeadingAge Wisconsin office at 608-255-7060 to provide your credit card information. Thank you.