Please Enter Your Details Below 
Please fill out the information below, then click "Continue" to proceed to the next step.

For questions or assistance, please contact Rachel Hischke at 920-465-2642 or 800-621-2313.

First Name
Last Name
Preferred First Name
Organization
Address
Position
City
State
Zip Code
Work Phone
Home Phone
Mobile Phone
Email Address
= required field


Alternate Payment Option

If you would like us to Invoice your Organization, please provide: Organization's Name, Department/Person, Address, City, State, Zip Code and Phone Number. Payment by personal check or credit card, will be available by selection on a future screen.

Invoice Organization

Dietary Requirements
Please list any dietary restrictions you may have.

Special Requests
Please list any special requests you may have.

= required field

For additional information, contact:

Joy Ruzek, Director of Continuing Professional Education

Phone: (920) 465-2222, Fax: (920) 465-2643, E-Mail: ruzekj@uwgb.edu