2018 GVP Conference Registration

Conference Registration Information

Fourth Annual GrapeVine Conference
Registration Form

Monday, June 18 - Tuesday, June 19, 2018
Sheraton Madison Hotel

If you are not currently a GrapeVine Partner, please call Nora Miller at 608-251-1675 Ext 103 to learn how to join our program!

1. Contact Information

First Name *This question is required.

Last Name *This question is required.

Company Name

Title

Street Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

County *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

2. Dates of Attendance

3. Dietary Restrictions
Please list any allergies or dietary needs.

4. Trivia Happy Hour

Following the conference sessions on Monday 6/18, all attendees are invited to join us for a casual happy hour gathering and trivia contest from 4:30 - 5:30 pm.

5. Networking
Several nurses have requested a list of other GrapeVine partners. May we share your contact information (name, phone number, and email address) with other conference attendees in a GrapeVine Directory document?

If you require special assistance, or if you have any questions about accessibility or accommodations,
please contact Nora Miller at nmiller@wwhf.org or 608-251-1675 x103. Thank you!