Online Registration Form

Mississippi Conference on Church Music and Liturgy

2010 Online Registration Form

After you submit this form you will receive an email acknowledgement

With instructions how to remit your registration funds

Payment by cash or check only; no payment by credit card available.

-To Confirm your Registration -

You must then submit a deposit of $100 (or the Full Conference Fee )

To: Dr. Mark Butler ~ 210. N. Leflore Ave ~ Cleveland, MS 38732

- Registration WILL NOT be Complete Until We Receive your Funds! -

Personal Information

Name		First	Last
Title

Address:
Address2:

City:

State:

Zip:

Phone: (Enter Without Dashes)

Email:

Church Information

Church Name:

Position:

Diocese:

Fees and Other Conference Details

Select Full or Weekend Only Conference

Private Room Add $125

Note: Private rooms are available for an additional fee in the order that registration deposits are received. The conference reserves the right to limit the number of private rooms if needed to accommodate housing needs of all participants.

Room Preference:

Inn

Cottage

Roommate Preference:

Name for the name tag:

First Time to Attend?

Yes

Scholarship Info - Subject to Availability

I am Applying for a Diocesan Scholarship

(For MS Residents Only)

Full Conference $250

Weekend Only $125

I am Applying for the

"18 to 30" Scholarship

(Please Supply a Letter From Rector)

Full Conference or Weekend

($300 Applied to the Fee for Either)

Home Page

eScoop