2019 Annual MACA Summer Conference Registration

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Registration Category *

First Name *

Last Name *

What is your Title? *

County/Organization *

Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Do you need to register any children under the age of the age of 14? (Children age 14 or older must be registered as a regular guest). *

Price list for Youth Ages 0-6 (no fee) Ages 7-13( $75) Ages 14 & Up ($150) Must register as regular guest

How many children are you registering ages 7-13? *

First Name & Last Name

Age of Child

First Name & Last Name

Age of Child

First Name & Last Name

Age of Child

First Name & Last Name

Age of Child

First Name & Last Name

Age of Child

If there is a group bowling event held during conference, would you attend? (Detials to be released at a later time.) *

Yes

Please select the events that you will attend (Please ONLY select the events you WILL attend) *

Monday Pre-Conference Session

Tuesday Breakfast

Tuesday Lunch

Wednesday Breakfast

Wednesday Lunch

Wednesday GALA & President's Reception

Thursday Prayer Breakfast

Will you be bringing a guest? *

Yes

Guest's First Name *

Guest's Last Name *

GUEST INFORMATION Please select events that events that your guest will attend (Please ONLY mark events that your guest WILL attend) *

Monday Pre-Conference Session

Tuesday Breakfast

Tuesday Lunch

Wednesday Breakfast

Wednesday Lunch

Wednesday GALA & President's Reception

Thursday Prayer Breakfast

Will you be bringing an ADDITIONAL guest? *

Yes ($150)

First Name of ADDITIONAL Guest *

Last Name of ADDITIONAL Guest *

ADDITIONAL GUEST INFORMATION Please select events that events that your guest will attend (Please ONLY mark events that your guest WILL attend) *

Monday Pre-Conference Session

Tuesday Breakfast

Tuesday Lunch

Wednesday Breakfast

Wednesday Lunch

Wednesday GALA & President's Reception

Thursday Prayer Breakfast

Will you be bringing a 2nd ADDITIONAL guest? (If you plan to bring more than TWO (2) ADDITIONAL GUEST, please contact Terence Norwood @ 662-325-3141) *

Yes ($150)

First Name of 2nd ADDITIONAL Guest *

Last Name of 2nd ADDITIONAL Guest *

2nd ADDITIONAL GUEST INFORMATION Please select events that events that your guest will attend (Please ONLY mark events that your guest WILL attend) *

Monday Pre-Conference Session

Tuesday Breakfast

Tuesday Lunch

Wednesday Breakfast

Wednesday Lunch

Wednesday GALA & President's Reception

Thursday Prayer Breakfast

Persons with disabilities, food allergies etc. that require special accommodations, please use the space below to notify conference coordinators.

Payment Type *

Mail Check

eCheck

Total {registration_category} + ({how_many_children_are_you_registering_ages_7_13} *75)+{will_you_be_bringing_an_additional_guest} + {will_you_be_bringing_a_2nd_additional_guest}

Make Checks Payable to:

Extension Center for Government and Community Development

Attn: MACA Annual Convention

Box 9643

Mississippi State, MS 39762

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