1 Start 2 Payment Method 3 Complete Name (first and last) as you would like it to appear on your name badge: * Position: Organization: Address: * City: * State: * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip: * Day Phone: Cell Phone: Email Address * Registration Fee All Meals are included in the registration fees. Conference registrations may be transferred. No Refunds. Please register me for: * Conference Registration - By October 21, 2022 - $199 Conference Registration - Through November 2, 2022 - $225 Conference Registration - Just in Time • $275 Presenter • $99 Student • $99 (If a student, College/university and status must be completed in the Comments box below.) Other If a student, College/university and status must be completed in the Comments box below. MealsCheck the meals you plan to attend. If you have dietary needs, check the meal you will attend and then note the special dietary request below. We will substitute the menu item listed but need to have an accurate record of meals you plan to attend. Thursday Luncheon Thursday Luncheon - Chicken Supreme Social Hour Social Hour - Light Hors d'oeuvres Thursday Dinner Thursday Dinner - select to see the 2 options Thursday Dinner: 2 options: Thursday Dinner: 2 options: Select one Thursday Dinner Meal: • Pineapple Poblano Glazed Pork Loin Thursday Dinner Meal: • Grilled Salmon Friday Breakfast Friday Breakfast Buffet Friday Luncheon Friday Luncheon - Chicken Teriyaki Special Dietary Needs:If you have special dietary needs, please let us know here. Also - please check-mark above all meals you plan to attend. We will need to give table/chair counts in addition to the special meal requests. We will contact you if necessary to discuss your request(s). Special Needs? Standard menu meals as noted Vegetarian Vegan Gluten-free (standard menu modified to be gluten-free) Specific food allergy (nuts, dairy, etc). Indicate the allergy below in Comments box. First Time Attending? This will be my first The Way Up conference Name on Participant List? Check here if you do NOT want your name, address, phone and email included on a participant list. For questions, please contact: Madelyn Ridgeway ConsultingPhone 319-830-7470Email madelyn@madelynridgeway.com Conference registrations may be transferred. No Refunds.Photographs and video may be taken at the conference. By registering, you agree to allow us to use your image. The Way Up requests this information for the sole purpose of registering you for this conference. We do not routinely release any of this information to anyone outside the conference without express permission. We do ask that you fill out all the registration items that apply to you. Thank you. The UNI Web Privacy Statement. Comments
