December 11-12, 2009 Holiday Inn Select Executive Center, Columbia, MO

You must fill out one form per person.

First Name:    Last Name:

Home Phone: (5555555555)   Fax Number:    Daytime Phone:

Mailing Address:

City:     State:     Zip:

School:

E:mail:

I am planning on attending the Hall of Fame Luncheon on Friday during the clinic.

The first 400 registrants will receive a complimentary clinic gift.

The registration fee is $100 (by December 1, 2009) or $115 (after December 1, 2009)and includes your 2009 MTCCCA dues.

Payment Options:
Please check your method of payment below.

Check - Make check payable to: Custom Meeting Planners, Inc.

Purchase Order - Must mail or fax {(573)445-1831} a copy of your purchase order to complete registration.

    Please provide the following information if you are paying by purchase order:

       Accounting Office Contact Name:                    

        Fax Number to Send Invoice:    

Credit Card - MasterCard, Visa and Discover accepted, please call (573)445-2965 to pay by phone.

Please send checks or a copy of your Purchase Order to:

Custom Meeting Planners
PO BOX 30785
Columbia, MO 65205
Fax:  (573) 445-1831

If you have a disability that requires special materials or services, contact Jamie Schieber at (573) 445-2965 by November 6, 2009.