REGISTRATION

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REGISTRATION

MEDC SUMMER CONFERENCE 2012
All Systems GO!
July 11 - 13 . IP . BILOXI

For additional information on Agenda, Sponsorships, Lodging and List of Registrants, go to www.medc.ms.

Conference fee covers all conference sessions, receptions, luncheons, breakfasts and breaks.

Registration packet will be available at the Registration Desk.

Completed form may be printed by choosing "File" and "Print"

First Name *

Last Name *

Title

Department / Division

Organization / Company *

Address *

City *

State *

Zip *

Email *

Phone *

Fax

Conference Fee - After July 1: *

MEDC members must be listed in MEDC directory at www.medc.ms. For new members, if membership application form and payment are made at the same time, register at the member rate. See Membership at www.medc.ms.

Non-MEDC Member --- $325 - after July 1

MEDC Member (individual membership) --- $225 - after July 1

Spouse or Student --- $145 - after July 1 - $145

Five or more from the same organization listed above -- $205 - after July 1

Sponsor Complimentary Registration (Must have filed sponsorship form with MEDC)

Activity Fee:

(open to all participants)

No activity

$85 - Golf (please fill in Handicap below)

$30 - Boating

$95 - Deep Sea Fishing

Option 5

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Handicap

Golfers, please give us your handicap

Spouse Activity Fees paid for:

Name & Activity

Total Remitted: *

Sorry, no refunds after July 6

Payment will be made by: *

Check will be mailed to MEDC, P. O. Box 3721, Jackson, MS 39207

Credit card online at www.medc.ms/Conferences

Please invoice me

You MUST click Submit for MEDC to receive your registration. However, if you wish to print your registration form, please print now before hitting submit.

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