Colombia Support Network

Registration Form

Colombia Support Network
2019 National Conference
June 7-8, 2019

Edgewood College
Predolin Hall
Madison, Wisconsin

Program and Conference Information: (put website link)
Full Name: ___________________________________________________________________
Mailing Address: _____________________________________________________________
City: ____________________ State/Province: __________________________
Zip/Postal Code: __________
Country: _________________ Telephone: () ___________________________
Email: ______________________________________________________________________
Any Dietary Restrictions: ______________________________________________________

Please check appropriate registration fee:

One Day                      $50
Two Days                     $100
Conference Presenter                     Free

*Included in the registration fee:  Light Breakfast, Lunch, and Dinner on Friday and Saturday, Coffee Breaks, 
Conference Booklet
*The General Public is welcome to attend portion of the conference for free, however no food or booklet is included

Please check appropriate payment method:

*Checks or cash accepted. Make checks payable to: WICOLA/Colombia Support Network with “National Conference” in the Memo Line.

Prepay (mail payments to the address below)                 
Pay on Arrival                  

Please bring completed registration form to the conference or mail registration form and/or payment to:
Colombia Support Network
P.O Box 1505
Madison, WI 53701-1505