2012 Midwest Service Leaders Conference Registration Form

Please register only one (1) participant per entry

The Conference will be held on November 10-11, 2012 at Marquette University.

* 1. Conference Participant Information

* 2. Emergency Contact Information

* 3. Payment Information

Conference Registration Fees: $50 ($40 for Marquette Students)

Registration includes all conference sessions, materials, a t-shirt, and three meals (breakfast and lunch on Saturday, and brunch on Sunday).

The conference fee does not include lodging accommodations. Please be sure to reserve lodging separately. Refer to the conference website for details.

If paying with a CHECK, please make payable to: Marquette University Service Learning Program
Mail checks to:
Marquette University Service Learning Program
707 N 11th Street, Suite 303
Milwaukee, WI 53233

If paying with a CREDIT CARD (Visa or MasterCard only), please call: Peggy Mead at (414) 288-5473
Have the following information available:
Name(s) of participant(s)
Card number
Expiration date
Name as it appears on the card
Billing address