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Trauma Invested Prac­tices in WI
  1. Novem­ber 13, 2018; Jan­u­ary 15, 2019; April 30, 2019
    Embassy Suites Brookfield

    This reg­is­tra­tion form works for indi­vid­u­als and groups of 5 or less. If there are 6 or more in your group, please con­tact us via email or at (262) 2423771.

  2. Registration Information

  3. Are you a CUR­RENT WASCD Member?
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  4. Join WASCD with this Reg­is­tra­tion form and reg­is­ter at the mem­ber price!

    Tip: Pur­chas­ing a year-​long WASCD mem­ber­ship for $89 will save you $100 on your pro­gram registration!

  5. Would you like to reg­is­ter for a WASCD Membership?
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  6. Please select your reg­is­tra­tion option
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  7. Please Select Your Reg­is­tra­tion Option
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  8. Mem­ber­ship Renewal
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  1. Contact Information

  2. Name
    Please input your name.
  3. School
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  4. District/​Agency
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  5. Job Role
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  6. If Other, Please describe
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  7. CESA #
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  8. Pre­ferred Address
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  9. Address
    Please input your address.
  10. City
    Please input your city.
  11. State
    Please input your state.
  12. Zip Code
    Please input your zip code.
  13. Phone
    Please input your phone number.
    For­mat: 5555555555
  14. Email
    Please input your email address.
    Con­sider giv­ing us a per­sonal e-​mail (ie gmail, yahoo, etc) in order to avoid dis­trict spam filters.
  15. When going to the next page, you may need to scroll up to enter more information.

  1. Participant #2 Registration Information

  2. Is this par­tic­i­pant a CUR­RENT WASCD Member?
    Invalid Input
  3. Join WASCD with this Reg­is­tra­tion form and reg­is­ter at the mem­ber price!

    Tip: Pur­chas­ing a year-​long mem­ber­ship for $89 will save you $100 on your pro­gram registration!

  4. Would you like to reg­is­ter for a WASCD Membership?
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  5. Please select your reg­is­tra­tion option
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  6. Please select your reg­is­tra­tion option
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  7. Mem­ber­ship Renewal
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  1. Participant #2 Contact Information

  2. Name
    Please input your name.
  3. School
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  4. District/​Agency
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  5. Job Role
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  6. If Other, Please describe
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  7. CESA #
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  8. Pre­ferred Address
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  9. Address
    Please input your address.
  10. City
    Please input your city.
  11. State
    Please input your state.
  12. Zip Code
    Please input your zip code.
  13. Phone
    Please input your phone number.
    For­mat: 5555555555
  14. Email
    Please input your email address.
    Con­sider giv­ing us a per­sonal e-​mail (ie gmail, yahoo, etc) in order to avoid dis­trict spam filters.
  15. When going to the next page, you may need to scroll up to enter more information.

  1. Participant #3 Registration Information

  2. Is this par­tic­i­pant a CUR­RENT WASCD Member?
    Invalid Input
  3. Join WASCD with this Reg­is­tra­tion form and reg­is­ter at the mem­ber price!

    Tip: Pur­chas­ing a year-​long mem­ber­ship for $89 will save you $100 on your pro­gram registration!

  4. Would you like to reg­is­ter for a WASCD Membership?
    Invalid Input
  5. Please select your reg­is­tra­tion option
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  6. Please select your reg­is­tra­tion option
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  7. Mem­ber­ship Renewal
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  1. Participant #3 Contact Information

  2. Name
    Please input your name.
  3. School
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  4. District/​Agency
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  5. Job Role
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  6. If Other, Please describe
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  7. CESA #
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  8. Pre­ferred Address
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  9. Address
    Please input your address.
  10. City
    Please input your city.
  11. State
    Please input your state.
  12. Zip Code
    Please input your zip code.
  13. Phone
    Please input your phone number.
    For­mat: 5555555555
  14. Email
    Please input your email address.
    Con­sider giv­ing us a per­sonal e-​mail (ie gmail, yahoo, etc) in order to avoid dis­trict spam filters.
  15. When going to the next page, you may need to scroll up to enter more information.

  1. Participant #4 Registration Information

  2. Is this par­tic­i­pant a CUR­RENT WASCD Member?
    Invalid Input
  3. Join WASCD with this Reg­is­tra­tion form and reg­is­ter at the mem­ber price!

    Tip: Pur­chas­ing a year-​long mem­ber­ship for $89 will save you $100 on your pro­gram registration!

  4. Would you like to reg­is­ter for a WASCD Membership?
    Invalid Input
  5. Please select your reg­is­tra­tion option
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  6. Please select your reg­is­tra­tion option
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  7. Mem­ber­ship Renewal
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  1. Participant #4 Contact Information

  2. Name
    Please input your name.
  3. School
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  4. District/​Agency
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  5. Job Role
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  6. If Other, Please describe
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  7. CESA #
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  8. Pre­ferred Address
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  9. Address
    Please input your address.
  10. City
    Please input your city.
  11. State
    Please input your state.
  12. Zip Code
    Please input your zip code.
  13. Phone
    Please input your phone number.
    For­mat: 5555555555
  14. Email
    Please input your email address.
    Con­sider giv­ing us a per­sonal e-​mail (ie gmail, yahoo, etc) in order to avoid dis­trict spam filters.
  15. When going to the next page, you may need to scroll up to enter more information.

  1. Participant #5 Registration Information

  2. Is this par­tic­i­pant a CUR­RENT WASCD Member?
    Invalid Input
  3. Join WASCD with this Reg­is­tra­tion form and reg­is­ter at the mem­ber price!

    Tip: Pur­chas­ing a year-​long mem­ber­ship for $89 will save you $100 on your pro­gram registration!

  4. Would you like to reg­is­ter for a WASCD Membership?
    Invalid Input
  5. Please select your reg­is­tra­tion option
    Invalid Input
  6. Please select your reg­is­tra­tion option
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  7. Mem­ber­ship Renewal
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  1. Participant #5 Contact Information

  2. Name
    Please input your name.
  3. School
    Invalid Input
  4. District/​Agency
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  5. Job Role
    Invalid Input
  6. If Other, Please describe
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  7. CESA #
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  8. Pre­ferred Address
    Invalid Input
  9. Address
    Please input your address.
  10. City
    Please input your city.
  11. State
    Please input your state.
  12. Zip Code
    Please input your zip code.
  13. Phone
    Please input your phone number.
    For­mat: 5555555555
  14. Email
    Please input your email address.
    Con­sider giv­ing us a per­sonal e-​mail (ie gmail, yahoo, etc) in order to avoid dis­trict spam filters.
  15. When going to the next page, you may need to scroll up to enter more information.

  1. Pay­ment Information

  2. Your total due
    0.00
  3. Please select your pay­ment choice.
  4. PO #
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  5. Please enter the billing infor­ma­tion where we should send the invoice:
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