Lake Terrace Convention Center Hattiesburg, MS

2017 MSAE Fall Conference Executive Registration Form Wednesday, October 4 – Friday, October 6, 2017 Lake Terrace Convention Center – Hattiesburg, MS

Name: ______

Organization: ______

Phone: ______Email: ______

Executive Member Registration Fees:

_____ $150 Executive Member, First Staff Registered

_____ $100 Additional Staff Member, Same Organization

_____ $100 First-Time MSAE Conference Attendee

_____ $150 Spouse or Guest

_____ $225 Non-Member (Association Executive)

_____ $25 Optional Hands-on Social Media Intermediate & Advanced Workshop

$_____ TOTAL DUE

Additional Staff / Guest

Name______Email______$25 Optional Hands-on Social Media Intermediate & Advanced Workshop

Return registration form via mail or email by September 20, 2017 to receive early registration rate. All registrations after September 20, 2017 will incur a $50 late fee. [email protected], P. O. Box 12467,Jackson, MS 39236 Credit Card Payments: received at www.msae-net.org or onsite Checks may be mailed to P. O. Box 12467, Jackson, MS 39236