Registration for: Mid-Winter Conference - Feb 4-6, 2009 Contact Information: Fields with * are required: *Name: MCOLES number: *Title: Department: Mailing Address: *City:   *State:   *Zip: County: *Phone:  Fax: Email: Spouse Name: (note: a full registration includes one banquet ticket - banquet ticket for a spouse is extra; see below)
Full Registration: Member $235 Life Member $110 Non-member $285 Extra Tickets for Thursday Banquet:    (note: banquet tickets are non-refundable)   $35 each Partial Registration: You may register for any number of half-day sessions:     Wed PM only $75 Thursday AM only $75 Thursday PM only $75 Friday AM only $75 Amount Charged:  Card Type: VISAMasterCard  Name on Card:  Card Number:  Expiration Date: JanFebMarAprMayJunJulAugSepOctNovDec / 20072008200920102011