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Workshop registration

A page within La Crosse Exercise and Health

To register for the workshop, please print the form below and mail it to the address indicated or fax it to 608.785.8686. If you register within 2 weeks of the workshop start date, please call 608.785.8683 to confirm space and to provide us with a number where we can fax registration materials and hotel information, if necessary.

(Print exactly as it should appear on your certificate.)

Job Title/Position________________/_________________

Hospital ________________________________________

Mailing Address__________________________________


City ___________________ State _____ Zip ___________

Business Phone (_____) _____- __________

Home Phone (_____) _____- __________

Fax Number (_____) _____- __________

E-mail _________________________________________


La Crosse Exercise and Health Program 
Education Services Unit 
221 Mitchell Hall 
University of Wisconsin-La Crosse 
La Crosse, WI 54601 
Fax: 608.785.8686



  • Regular Price: $625 _____
  • AACVPR or Affiliate Member Price: $600 _____

Please make your check payable to the La Crosse Exercise and Health Program and mail it to:

Cashier's Office
University of Wisconsin-La Crosse
121 Graff Main Hall
1725 State Street
La Crosse, WI 54601