HWW Conference Registration

HealthWatch Wisconsin

Conference Registration

11th Annual Conference!

Name: Enter Full Name

Required

Address: Enter Address

Required

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Please call 608.261.6939 ext 217

You are now registered!

If you're paying by credit, proceed below to payment.

Title: Enter Title

Required

Email: Enter Email

Required

Phone (with area code): Enter Phone #

Required

Do you have any dietary restrictions? (some may entail an additional fee from the caterer)

Do you require any other accommodations to make the conference more accessible?

Are you a current HealthWatch Wisconsin member?

Required

Yes

March 7

Required

FREE

$200

$FREE

March 8

Required

$125

$180

$300

$50

Both Days

Required

$125

$180

$500

$50

Check

Required

Invoice

Required

Credit Card

Required

Employer: Enter Employer

Member

Membership + Member

Full Conference

Full Time Student

Payable to: HealthWatch Wisconsin, Inc. Mail checks to: 32 N. Bassett St. Madison, WI 53703

We will submit an invoice to the email address above.

Pay online after submitting this form.

(?)

STEP 1: Complete this form

STEP 2: Select Days & Payment Type

STEP 3 (if paying by Credit): Checkout

March 7

March 8

Both Days

Members

Membership + Member

Full Conference

Full Time Student

HealthWatch Wisconsin, Inc. a subsidiary of ABC for Health, Inc., promotes improved access to health care coverage and services. HealthWatch will continue to track and inform policy developments in a changing landscape of public and private insurance coverage options for the people of Wisconsin.

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