WIFLE
Conference Fee PAYMENT FORM
Tenth Annual Leadership Training Conference
Print, Fill Out, and Send
Name: _____________________________
Agency: __________________________
Address: ___________________________
Address: ___________________________
City: ___________ State: ____ Zip: _____
Phone: ____________________________
Fax: ______________________________
Credit Card or Check:
___VISA ___MasterCard ___Check
Nr._________
3 or 4-Digit Reference Number: ________
Card Number: _______________________
Expiration Date: ____________
___________________________________________
Card Holder’s Name (Please print)
____________________________________________
Signature of Card Holder
____________________________________________
Contact eMail and Telephone Number of Card Holder
Mail to:
WIFLE Conference Support
12600 Kavanaugh Ln
Bowie, MD 20715
Phone: 703-548-9211 Or 877-850-8302 (toll-free)
Fax: (301) 560-8836
| For
your training purposes, the WIFLE Foundation, Inc. Federal Tax ID is 20-4532945.
The Foundation, Inc. is a charitable and education organization,
501(c)(3). If your agency requires something else from us,
please just let us know. |
***********************
List Names below for whom
payment is being made.
|