First Name:
Last Name:
Position:
School
School Address:
City:
Zip:
E-mail:
School Phone:
School Fax:
Name as it should appear on badge:
SPOUSE/GUEST INFORMATION:
First Name:
Last Name:
Name as it should appear on badge::
OTHER INFORMATION
This is my first MEMSPA Conference:
Please indicate if you require special assistance during the meeting:
CONFERENCE - Dec 1-3, 2008
Active/Associate/Aspiring/Contract Retiree Member		$ 299.00	Banquet/Breakfast tickets included
Retiree Member (not Contract Retirees)		$ 0.00	No Meals Included
Non-Member		$ 359.00	Banquet/Breakfast tickets included
Extra Banquet Ticket(s) @ $40.00 each
Extra Breakfast Ticket(s) @ $10.00 each
Vegetarian dinner(s) requested
PreConference Workshops:
	Turn Up the Dial
Member		$69
NonMember		$99
	New Principals
Member		$99
NonMember		$129
Clear Workshop Selections:
TOTAL FEES:

Method of Payment:
		School P. O. #
		Credit Card
Card Type:		VISAMasterCard
Name on Card:
Card Number:
Security Code:		(3 digit code on back of card)
Expiration Date:		JanFebMarAprMayJunJulAugSepOctNovDec/20082009201020112012201320142015
MEMSPA will retain 50% of the registration fee if canceled after 11/21/08.