2017 MMEA Conference Group Registration

2017 MMEA In-service workshop conference

This form is to be used ONLY if entering multiple registrations

to be paid with ONE check.

Plese note the instructions below:

1. Primary Contact Information must be entered on at least ONE of the registrations (but not all).

2. Each member registration must be entered separately.

*Click submit after each registration & then return to the registration form by selecting the link located on

the confirmation page.

3. List the name of the SCHOOL if all registrations are from the same school.

**NOTE: Please enter the school name exactly the same on each registration

4. List the name of the DISTRICT if registrations are from multiple schools within the district.

**NOTE: Please enter the district name exactly the same on each registration.

5. Upon completion of registrations, an invoice will be sent to the Primary Contact via email.

NOTE: Payment for group pre-registration is by CHECK ONLY.

(Sorry, credit/purchasing cards are not accepted at this time.)

GROUP REGISTRATION WILL BE AVAILABLE THROUGH NOVEMBER 30, 2016.

Name of School District*

*Please enter the name of the SCHOOL if all registrations are from ONE school exclusively. **Please enter the name of the school DISTRICT if the registrations are from multiple schools.
Primary Contact Name

List the name of the person to be contacted should there be any questions regarding individual registrations and/or payment status.
Primary Contact Email

Must be included on at least one of the registrations entered (but not all).
Primary Contact Phone #

Must be included on at least one of the registrations entered (but not all).

MEMBER REGISTRATION INFORMATION
Member Name*
First Last
Member Primary Email*
Member NAfME Number*

*Must total 9-digits. (Add "zeros" to the beginning of the number to total 9 digits.)
NAfME Membership Expiration Date*

Please enter Month/Year (Ex: 02/2017) **NOTE: If your NAfME membership expires in February 2017 or before, you must renew your NAfME membership priour to the MMEA Conference.
Member Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Member Primary Phone #*

Registration Information
Registration Fees*
- MMEA Member ($70)
- Spouse/Significant Other ($5)
- Guest 1 ($5)
- Guest 2 ($5)
Check all that apply
Conference Pre-Sessions
- Conference Pre-Session 1: Mentoring (No Fee)
- Conference Pre-Session 2: "Music Therapy Ideas for Music Education" ($15)
- Conference Pre-Session 3: "Put On Your Dancing Shoes" ($15)
Check all that apply.