Legislative Day, February 16, 2010 Registration

PLEASE FILL OUT THE FORM FOR EACH OF YOUR REGISTRATIONS.

Please select the applicable fees.

Registration Fees
Full Registration	$10

First Name

Last Name

Middle Initial

Business Name

Business Address Location

City

State

Zip Code

Business Phone

Home Phone

Is your place of employment a TLW member? Yes No

If Yes, Specify County/League

Method Of Payment

OPENS A NEW WINDOW

OR Pay by Credit Card Online

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(ex: ##/##)
Credit Card Expiration Date

(last digits on the back of card)
Credit Card CSC code

Name on Credit Card

Credit Card Address

Credit Card City

Credit Card State

Credit Card Zip

Credit Card Phone

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Member Login

Contact Information

2817 Fish Hatchery Rd.
Fitchburg, WI 53713

Phone: (608) 270-8591
Fax: (608) 270-8595