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Workshop information Workshop Name 2021-2023 Madison CPM Colleague Group Date November 9, 2021-April 14, 2023 Location Herzing University, 5218 E Terrace Dr, Madison, WI 53718 Deadline 07/30/2022 Price $4,400.00 2021-2023 Madison cohort of the CPM Colleague Group   Participant information * - required Last Name * Required! First Name * Required! Suffix Organization Name * Required! Title/Position * Required! Address * Required! Address 2 City * Required! State * Required! Zip Code * Required! E-mail * Required! To contact you about your registration Phone * Required! Please include area code, XXX-XXX-XXXX   Please provide the following demographic information about yourself. This information is used to ensure our programming is reaching a diversity of audiences and to fulfil our obligations as a recipient of federal funding. You reserve the option to not provide this demographic information. Should you choose to not provide this information, please choose "Prefer not to respond."   Please indicate your race. Choose only one answer. I identify as having (check all that apply):   American Indian or Alaska Native (1)   Asian (2)   Black of African American (3)   Native Hawaiian or Other Pacific Islander (4)   White (5)   Two or more races (6)   Prefer not to respond (7) Please indicate your ethnicity. Choose only one answer. Hispanic or Latino (1) Not Hispanic or Latino (2) Prefer not to respond (3) Please indicate your “Sex”. Choose only one answer. Female (1) Male (2) Prefer not to respond (3) Please indicate your age. Choose only one answer. Adult (19 years or older) (1) Youth (18 years or younger) (2) Prefer not to respond (3)   If you have a Promo Code, please enter it here Registration Category $4,400.00 Payment Method Credit Card Check   Doing Business As: The charge will appear on your credit card statement as UW Local Gov. Education. Cancellation Policy: To cancel a registration/payment, please contact lgc@extension.wisc.edu. Privacy Statement: The Local Government Center does not sell, rent, trade or distribute any personally identifiable customer information to any third party, except as required by law. Information collected by The Department of Animal Science is used for the administrative and operational purposes of our services. Contact: Please contact lgc@extension.wisc.edu, if you have any questions about your registration. NOTE: If you have a disability and desire accommodation, please advise us as early as possible. Requests are confidential.