Archives Form

Registration Form: Friday, August 19 and Saturday, August 20,2016

Best Western Plus Hotel & Conference Center * 5625 O’Donnell Street

MAIL: Check payable to MCCPAI, Registration form and a COPY (NOT THE ORIGINAL) of your MCCPAI membership card to:

c/o Yvonne Turner 443 813-7912

1717 Broening Highway * Baltimore, Md. 21224

Registration Fee Includes: Venue, Honorariums, Friday and Saturday Sessions and Awards Ceremony, etc.

* = Required Information

Please Print Clearly:

Director

Manager

Owner

Staff

Name *

Address *

City *

State

Zip *

Phone Number

Daytime

Evening

Cell Number

Email *

Check how you wish to receive Confirmation by:

Mail

MCCPAI Member?

Yes

*If yes, you must include a copy of your MCCPAI Membership card or you will responsible for the non-member fee.

Member Registration: $200.00 Non-Member Registration: $250.00 At Door:$275.00

CANCELLATION POLICY: Registration fees are NON-REFUNDABLE due to the expense of preparing and planning for the conference.

DEADLINE FOR REGISTRATION IS August 12, 2016

Natalie Thomas, B.S. President

Yvonne Turner, B.S. Secretary

Tonya Hailey, Treasurer

Jamari Nicholas Financial Secretary

Dr. Denise Folks Chaplain