SRPLN || Southern Program Leadership Development

2010 SR-PLN, AEA & ASRED Joint Meeting

Online Registration Form

Download Printable Version [PDF]
Title:	First Name (Preferred):	Last Name:

Position:	Organization:

Address:

City:	State:	Zip Code:

Contact Name	Contact E-mail:

Participant E-mail:

Phone:	Fax:

Which of the following will you be attending?
	Please view table below for pricing information.
I will be participating in the Urban Task Force Pre-Conference Activities at 1:30-4:30 p.m. on Monday, August 23rd. Yes No

Please select your primary committee:

Conference	Early Bird Price (By July 15th)	Late Price (After July 15th)
PLN Meeting	$300	$325
AEA/ASRED	$300	$325
PLN & AEA/ASRED	$375	$400

Are you a first-time attender of the Joint Meeting?
If you are a first time attendee of the joint PLN Conference, please make plans to attend the Newcomer Orientation at 5 p.m., Monday, August 23, 2010. Yes, This is my first time to attend the Joint Meeting. No, I have attended at least one Joint Meeting before.

Will you be bringing any guests?

Yes, I will be bringing guests.*
No, I have no guests joining me.

*-A fee of $75 will be charged per guest.

Please note that, in order to protect your information, the SRDC can no longer accept credit card information online. Please call Abbie Misso at 662.325.3207 to give us your credit card payment information.

Send checks to:
Southern Rural Development Center
Attn: Abbie Misso
Box 9656
190 Bost-North
Mississippi State, MS 39762