MASA 2010 Spring Leadership Conference True and Proven Leadership
April 18 - 20, 2010 Hilton Hotel - Jackson, Mississippi
Registration Form - Please type or print plainly
Name: Title:
District:
Address: E-mail:
City, State, Zip:
Phone:_ Fax:
Contact Person: E-mail:
RegistrationFees
$125.00 - Pre-Conference Session (Sunday, April 18)
I would like to join MASA - $125.00 - MASA Annual Membership Dues
Method of Payment
Enclosed is my check # in the amount of $
Please bill my school district for purchase order #
Please charge my credit card #
___ Visa ___ MasterCard ___ DiscoverCard
Amount: Expiration Date:
Signature:
Make checks payable and mail to: MASA, P. O. Box 326, Clinton, MS39060 or fax to 601-924-7498.
Registration confirmations will be e-mailed to the address listed on this form. We welcome inquiries regarding receipt of your registration. Call 601-924-7498 or e-mail masa4@comcast.net.
Only conference cancellations received by April 9, 2010 will be eligible for refunds. Contractual obligations with the conference facilities make it necessary that we strictly adhere to this deadline.