Registration
MPMA 2009 Summer Conference
The Inn at Bay Harbor, Bay Harbor, Michigan
July 9 - 12, 2009


(Please check spelling. Names will appear on name badges as entered.)

Contact Information
Name Email
Address
City State Zip
Phone Fax
Spouse/Guest Name (for Name Badge only):
Additional Guest Name (for Name Badge only):

Tuition MPMA/APMA Members: $350.00
MPM/APMA Senior Members: $225.00
MPM/APMA Life Members: Free
Non-MPMA/Non-APMA Members: $550.00
Residents: $100.00

Activity Registration
   I plan to attend the Exhibitor Wine and Cheese Reception on Thursday, July 9 from 5:00 to 7:00 pm. 21 and older only.
   I plan to bring a Spouse/Guest. (Name Badge is required for Spouse/Guest)
   I plan to bring an additional Guest for an additional cost of $30.00. (Name Badge is required for Guest)

Donation Amount (optional):

Payment Information
Check #
(If unknown, please enter N/A to indicate payment by check)
Please mail all checks to: 1000 West St. Joseph Hwy, Ste 200 Lansing, MI 48915

Or
Visa Master Card American Express

Credit Card #
Exp Date
Name on Card:

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