WIU-QC Event Registration

You can register up to 4 people with this form. If you properly fill out the form and submit, you should see a message that says "Thanks. Your response has been recorded and e-mailed to the WIU-QC" If you don't see this message, you need to update or add missing information which will be highlighted on the form in red color. A confirmation e-mail will be sent back to you within a couple of days once your registration is successfully submitted.

After successfully registering using this form, please provide advance payment with one of the three additional options listed below:

1. Pay on-line at the WIU-QC webpage to use PayPal or a credit card which is a secure transaction.
2. Mail in a check made out the Western Illinois University, Attn: Bill Jorgesen, 3300 River Drive, Moline, IL 61265
3. Include a PO number and we will bill you.

The information you submit will only be used by WIU-QC and will not be redistributed or sold.

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