Corporate Discount Registration

COMPANY INFORMATION

Company*

Business Type*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

COMPANY CONTACT / ROSTER ADMINISTRATOR

Name*

First NameLast Name

Title/Position*

Email*

Phone*

Will you be the day-to-day contact managing your membership roster?*

YesNo

Admin Name*

First NameLast Name

Admin Title/Position*

Admin Email*

Admin Phone*

MEMBERSHIP INFORMATION

Registration Type*

# Members*

Discount*

Please indicate the number of memberships requested for each chapter.

IMPORTANT: Please be sure your allocation is completed accurately. Roster slots are configured exactly based on the chapter and number you submit. Check that the sum of the allocations matches the number of members above.

Once you have selected the number of slots, do not scroll to the next section as this could change your number(s). Move your mouse/pointing device to the next section and click.

Allocation*

PAYMENT INFORMATION

Do you wish to pay by credit card?*

When you click on the Submit button at the bottom of the page, you will be taken to the checkout page to enter your credit card information. You will receive a confirmation after submission.

Please select the discount level and use the dropdown arrow to select the correct quantity.

Form of Payment *

one-time, single payment

Invoice Required?*

Memberships*

5 to 10 Members10% off $100 = $90 per person

$90.00 Quantity

11 to 20 Members15% off = $85 per person

$85.00 Quantity

21+ Members20% off= $80 per person

$80.00 Quantity

Total

$0.00

Please make sure your quantity above matches the total number of memberships you are purchasing. Use the dropdown to select the correct number.

Remarks

Reply to Email*

DoNotReply@wiseworks.org

Please verify that you are human*

Please doublecheck your allocations.

You will receive an email confirmation that will include a copy of this registration. If you would like to print a copy, please click on Print Form before you submit.