Request edit access
2019 WiRSA Conference Registration
Conference Registration

If you are completing this registration for someone else, please be sure to give us their correct contact email information

Email address *
Registrants Name and Position *
Your answer
School District/Organization/Business *
Your answer
Name of Main Contact/ Email/ Phone *
Your answer
2nd Registrant Name
Your answer
3rd Registrant Name
Your answer
4th Registrant Name
Your answer
5th Registrant Name
Your answer
Registration Type *
Payment Method *
Billing Information (Provide Name, Email and Phone) *
Your answer
To eliminate food waste, we are asking for your help with attendance at each of our events. Please select how many people will be attending the following functions throughout the conference.
Welcome Reception (Sunday Evening)
Breakfast (Monday)
Lunch (Monday) WiRSA Award Ceremony
Evening Reception/ Auction (Monday)
Breakfast (Tuesday)
WiRSA Auction on Monday Evening, October 28. To raise additional monies for student scholarships for our member schools, we have added an auction to our conference. Each attendant is asked to bring an item that represents their hometown/ business. *
If you have any questions, please contact Kim Kaukl at (608) 553-0689 or
Your answer
Never submit passwords through Google Forms.
This form was created inside of Wisconsin Rural Schools Alliance. Report Abuse - Terms of Service