HCC Registration Page - Wisconsin Healthcare Engineering Association

HCC PROGRAM REGISTRATION

"*" indicates required fields

Registration and Fees:*

$225.00 - Early Bird Pricing (ends January 1)

Name*

First Last

Title*

Email*

Organization*

WHEA Chapter*

If you have actually paid dues to a Chapter, please pick which chapter here. If you have not, pick "Not a WHEA Member"

Address*

Street Address City State Zip

Work Phone*

See the phone format needed. Do not put a "1" before your phone number.

Representation*

Please identify the type of facility or industry and field you represent:

Please Specify Other:*

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Note: See registration flyer for further information on cancellation rules and cancellation fees. All registration fees must be paid in advance.