First Name:          *      * required information

 Last Name:          *

 Primary Email:       *

 Country:              *

 Business/Work Phone (if any) include area/region code

 Home Phone                         include area/region code

 Alternate Phone:                    include area/region code

  One phone number above required *

 Mailing Address (number & street): *

 City: *

 State: *  Postal/Zip Code: *

 Website address (if any):  

 Type of WABC World Connection: select either one box below
     for more information on membership types click here Program or Individual or Partner passports   
   
    Program Passport - "seeing" and "being seen" 
           $195 US  12-month connection     code
    Special Offer on Program Passport  
         $195 US   $145 US  taking advantage of special offer by submitting article or speech text           

          
 Program/Business Name
           My position/title with the program is:             

           Program/pool is located in what city?:        

If you have more than one program location by the same name/owner, and wish
to have it/them also listed in Highly Visible Programs, you may purchase additional
location listings at $45 US each $25 ea. (special offer through

May 15, 2008*). If location is in the same city advise of the appropriate description (e.g. North Tampa location and South Tampa location)
This makes it easy for parents and other swim professionals to immediately
locate you and see all the areas in which you operate - they are then more
likely to contact you.  (If you have many locations, email us for a rate quote.)

   Additional program locations listing please for the following: 
  *  just $25 per program location listing for those connecting with WABC by
      May 16, 2008.  $45 regular price thereafter - better grab this at the
      discount while you can!

      

* upon receipt of your completed connection form, WABC will email you regarding the detailed information on your location(s) & photo for your Highly Visible Programs listing and to ask about what information you are most interested in seeing.

     Individual Passport - "seeing"   $95 US   12-month connection
         - how about the Program Passport above for the same price?  O.K.?  :-)
 

     Special Offer on Individual Passport
           $95 US   $45 US  taking advantage of special offer by submitting an article or speech text     

 How many years have you been teaching?  If you are certified, by whom?
 What is your teaching setting?
     * upon receipt of your completed connection form, WABC will email you to ask
       a little bit more about you and what information you are most interested in seeing.

taking special offer - article/text will be sent at this time (a day or two)

taking special offer - article/text will be sent within 30 days

 

       Partner Passport - suppliers & services to learn to swim programs

                                                    $495 US   12-month connection

       Partner Passport - suppliers & services to learn to swim programs

 Total amount for my/our connection in US funds

 

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 Payment: Mastercard , Visa or US bank check in US funds.        

Cardholder NAME   *

Cardholder's Street Number & Street Name *

Cardholder's card billing address Postal/Zipcode *

Card Number       

Expiration date (month, year)        *

3-digit CVV2 code on back of card  * what is the CVV2 code

Note: For your credit card payment to be completed all the above card information
is to be the account holder's account information that is on file with Mastercard
or Visa. And must be included whether you email submit, fax or postal mail this form.

 

You may also send a check on a US bank in US funds. WABC Mailing Address
 Expect my check soon for the amount about entered above
     Simply complete and submit this form, indicating that you will pay by check
     or you may print this page, complete the form and include as you mail in your check.
    

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 How did you hear about WABC?

 Referred by anyone?:           

 Which WABC conferences have you attended?

Anything else you would like to say at this time?  (enter additional comments here)

Thank you for connecting to the through WABC