54th Winter Institute Registration February 10-11, 2015 | St. Cloud, Minnesota

54th Winter Institute Registration
February 10-11, 2015 | St. Cloud, Minnesota
Participant Information
Name (First)
(MI)
Company
(Last)
Email
Address
City
State
Work Phone
Birth Date
Zip Code
Please register me for the following:
$25 individual sponsorship ticket for Outlook Reception and Entertainment only
$40 individual sponsorship ticket for Thursday programming only
$60 individual sponsorship ticket for both days of programming
$500 Gold level sponsorship (includes 8 tickets to each day of programming, vendor booth and advertising)
$350 Silver level sponsorship (includes 4 tickets to each day of programming and advertising)
Payment Information:
Payment may be made by credit card, check or money order, made payable to St. Cloud State University
Check or Money Order in the amount of:
Check or money order is payable to SCSU. A $30 service charge will be applied if returned for insufficient funds, closed account or Stop Payment request.
Please bill my institution/employer, reference Purchase Order Number
Visa
Please charge my credit card in the amount of $
Card Number
Master Card
Exp. Date
Security Code
Discover
Name as it appears on your credit card bill
Address as it appears on your credit card bill
City
State
Zip Code
Authorized Signature:
Register one of four ways: mail, email, fax, phone.
To register by mail please print and mail to the address below. To register by email please print, scan and email to the address below. To
register by fax or phone please fax/call the numbers listed below. A confirmation letter and map will be emailed.
Mail: SCSU- Welcome Center
Email: [email protected]
Attn: Kim Loesch
Phone: 320-308-6100
355 5th Avenue South
St. Cloud, MN 56301