Which county or region do you represent? (If not in Wisconsin, please input "Out of State")
Please select the group that BEST describes you:
Upon completion of the regional broadband workshops, Extension plans to conduct interviews with participants to help us improve our programs and services. May Extension staff contact you via email or phone to inquire about participating in its evaluation efforts?
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Demographic Information
Understanding the demographics of our participants helps us improve Extension programs and services. Asking for the following information also helps us meet our institutional requirements for compliance with Federal non-discrimination policies. Providing us with this information is voluntary. You are not required to fill out this form to participate in Extension programs. If you have any questions about this form or why Extension collects this information, please contact: Kim Waldman, Compliance Coordinator & Equity Strategist, UW-Madison Division of Extension, (608) 263-2776, kim.waldman@wisc.edu .
Please select the option below that best describes how you identify:
Please select the option below that best describes your ethnicity:
Please select the option(s) below that best describe your race
Please select the option below that best describes your age:
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Please indicate any dietary restrictions or accommodations you may need
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Summary
Terms and Conditions
Registrations for this event are nonrefundable.
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Payment
**University of Wisconsin employees cannot pay for their registration with a university purchasing card. Please select "funding string" and email conferences@union.wisc.edu with your funding string information to complete payment.**
Please make all checks payable to: UW Conferences & Events - Broadband Workshop Mail Check Payments to: UW Conferences & Events - Memorial Union 800 Langdon St Madison, WI 53706
Doing Business As: The charge will appear on your credit card statement as WU-Conference Management.
Privacy Statement: The University of Wisconsin does not sell, rent, trade, or distribute any personally identifiable information obtained from clients to a third party, except in cooperation with government agencies or as required by law.
Please contact us at Wisconsin Union Conference Management, (608) 890-2645 or conferences@union.wisc.edu .
Cancellation Policy: Registrations for this event are nonrefundable.
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