Registration Form

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Mississippi Conference on Church Music and Liturgy

2009 Online Registration Form

Please return this form with the deposit of $100 By July 12, 2009

(or the total fee of $560 or $325 as noted in fees section)

Make checks payable to: Mississippi Conference on Church Music & Liturgy

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

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

Personal Information

Name (Mr. Mrs. Ms. Rev. Dr. other_____):

Address:

Address2:

City:

State:

Zip:

Phone:

Email:

Church Information

Church:

Diocese:

Position:

Fees and Other Conference Details

Full Conference $560	_________	Total Amount Due:	_________
Weekend Conference Only $325	_________	Amount of Deposit:	_________
Private Room Add $115	_________
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 Assistance

I am requesting a

Diocesan Scholarship

(For MS Residents Only)

Full Conference (Worth $300)

Weekend (Worth $150)

I am requesting the

"18 to 30" Scholarship

(Please Supply a Letter from Rector)

Full Conference or Weekend ($325 Applied to Fee for Either)

For Other Information

Write: Mississippi Conference

5400 Old Canton Rd.

Jackson, MS 39211

Email: Ellen Johnston:

ellenjohnston95@hotmail.com