WIFLE 
Mail/Fax PAYMENT FORM
Seventh Annual Leadership Training Conference
(If registered online, Right Click 
to PRINT this form to make payment 
by check through the mail, or to pay
by credit card through the mail or 
through fax.) 

If not registered online, use THIS FORM
instead to register and make payment.   

Name: _____________________________

Company: __________________________

Address: ___________________________

Address: ___________________________

City: ___________ State: ____ Zip: _____

Phone: ____________________________

Fax: ______________________________

Credit Card:
 ___VISA    ___MasterCard    

3 or 4-Digit Reference Number: ________   

Card Number: _______________________

Expiration Date: ____________ 

___________________________________________
Card Holder’s Name (Please print)

____________________________________________
Signature of Card Holder

Mail or Fax to:
WIFLE
Conference Registration
PO Box 1480
Edgewater, MD 21037-7480
E-Mail: cbaumgardner@timeandconvenience.com
Phone: 866-399-4353 Or 866-39WIFLE
Fax: (410) 451-7373
>>Please note: WIFLE Privacy Policy

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List Names below for whom
payment is being made.