WAPA 2027 Spring Conference Interest Form
Tell us how you’d like to participate and share your contact details—conference details and opportunities will follow.
Contact Information
First Name
*
Last Name
*
Professional Credentials
Job Title or Role
*
Organization or Employer
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other
Prospective Attendee Information
Professional role
*
PA
PA student
Physician
Nurse practitioner
Clinical nurse specialist
Certified registered nurse anesthetist
Certified nurse-midwife
Registered nurse
Healthcare administrator or executive
Educator or faculty member
Other
Current WAPA membership status
*
Yes
No
Unsure
Not applicable
Preferred attendance type
*
Please Select
Full conference
Single-day attendance, if available
Student registration
Group or organizational registration
Volunteer opportunity
Not sure yet
Conference topics of most value
Clinical education
Healthcare leadership
Wisconsin legislative and policy updates
Practice management
Professional development
Rural healthcare
Emerging healthcare technology
Career development
Networking
Other
Interest in lodging or a conference hotel block
Yes
No
Maybe
Partner, Sponsor, or Exhibitor Interest
Organization Name
*
Organization Website
Primary Contact Title
Type of Organization or Industry
How is your organization interested in participating?
*
Conference partner
Event sponsor
Exhibitor
Educational institution
Product or service demonstration
Meal, refreshment, or hospitality sponsor
Attendee giveaway or conference materials sponsor
In-kind contribution
Not sure—please contact me to discuss opportunities
Other
Primary goals for participating
*
Brand visibility
Meeting PAs and other advanced practice clinicians
Recruiting
Promoting an educational or graduate program
Introducing products or services
Building professional relationships
Supporting healthcare leadership and professional development
Other
Approximately how many representatives might attend?
1
2
3 or more
Not sure yet
Organization details and opportunity interests
Preferred method of follow-up
*
Email
Phone
Either
Final Questions
How did you hear about the WAPA 2027 Spring Conference?
Please Select
Email
Website
Colleague
Social Media
Event Announcement
Other
Anything else you would like the planning committee to know
I agree to receive information and planning updates about the WAPA 2027 Spring Conference. I understand that submitting this form does not constitute conference registration or a binding sponsorship commitment.
*
I agree
Submit
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