MACA Membership/Convention Registration
Name ________________________________________________________________
School Affiliation ________________________________________________________
Email Address __________________________________________________________
Alternate Email _________________________________________________________
Fees:
Membership (circle one)
Individual Membership $25 Two from same school $40 Three from same school $55
Additional Member Names and email:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Conference Registration
$25 X 1= $25 X2= $50 X3= $75 X4= $100
Breakout Session Ideas you would like to present or see presented.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Would you like to be a presenter next year? (Check one.)
( ) Yes! ( ) No. ( ) I’m thinking about it.
Print and Mail to:
Dr. Al Nicolai
1000 South Silver Springs Rd
Cape Girardeau, MO 63703