Treasurer Use Only:
Registration Received: ______ Payment Received: ______ Check #______ Cash: ______
WIM Conference Registration Form
Please complete only one registration form per person and PRINT clearly.
City, State, Zip Code
Check one: Student ___ Faculty ___ Guest ___ WIM Officer ___ WIM Officer Adviser ___
Friday Tour Selection
Please indicate your first (1), second (2), and third (3) choices for your tour selection. Some tours will
have limited availability depending on a tour stop’s ability to accommodate groups.
___ Fashion Merchandising
___ Food, Nutrition, Dietetics, and Hospitality
___ Human Services
___ Interior Design
Registration must be postmarked by January 27, 2010.
Payment must accompany registration or late fees will apply.
Registration is not complete without payment.
Receipts for registration will be distributed at the conference.
_______ $60 Early Bird Registration Fee (Postmarked on or before January 27, 2010.)
_______ $70 Late or On-site Registration Fee (On-site must pay at conference;
mailing payment after conference is not permitted.)
Please make checks payable to: WIM Conference
Please return this registration form and your registration payment to:
Northwest Missouri State University
312B FCS Dept., 800 University Drive, Maryville MO, 64468-6015
If you have questions, please contact: Email: email@example.com
Phone: (660) 541-0013 or (660) 562-1169