Conference Registration Form

Your First Name (required)

Your Last Name (required)

Your Email (required)

Title

Municipality/ICON# (required)

MCMA Conference Cancellation/Refund:
I understand that Registration fees less an administration fee of $50 will be refunded in the event that the registrant is unable to attend the MCMA conference up to and including September 20. Registrants will be expected to pay the full registration fee if cancelled after September 20 to cover the costs already incurred by MCMA.

Photo Release Waiver:
I understand that by registering for this conference, I hereby give the MCMA authorization for the use, reproduction and publishing of photographs that include my image or likeness. I understand that this material may be used in various publications and/or websites or other purposes as the MCMA may determine. I hereby waive the right to inspect, approve or alter any use of my image or likeness by the MCMA pursuant to my registration.

Dietary Preferences
regularvegetariangluten freevegan

Will you bringing a guest for dinner? If so, please make sure to select "Additional guest for Sunday Night Reception & Member’s Dinner" below.
yesno

Please tell us of any allergies you have:

[honeypot website]