2022 WELS Historical Institute Bus Tour Personal InformationParticipants must register separately. Name(Required) First Last Mailing address(Required) Address line 1 Address line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip code E-mail(Required)A confirmation e-mail will be sent to the e-mail provided. Enter e-mail Confirm e-mail Phone(Required)Describe any special dietary requirements or mobility concernsBilling InformationRegistration fee(Required)Fee includes lunch. Member fee $60 Non-member fee $85 Total $0.00 Credit or Debit card information(Required) DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration date Security code Name on card Billing address(Required)The address you enter must match the address on file with your bank/credit card company. If the address is not correct or if required fields are left blank, an error message will display. Same as mailing address (MUST MATCH WITH BILLING STATEMENT) Address line 1 Address line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip code Data Privacy & Permission(Required) I AGREE with the terms of the WELS Privacy Policy.NOTE TO EU RESIDENTS: By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy. Δ Contact Joel Pless at joel.pless@wlc.edu Ref: 2022 WELS Historical Institute Bus Tour