MAGPS Conference Registration

Registration Deadline: April 16, 2010.

Late Registrations accepted on Space Available Basis

MAGPS Member?

Join MAGPS $50 regular

Already an MAGPS member

Join MAGPS $25 retired or student

1st Time Attendee (membership incl)

Not interested in membership

Contribution to Student Scholarship Fund

Total Amount Due

As soon as we receive your payment we will finalize your registration and process your small group reservation. After you submit your registration, you can either mail us your check or pay by credit card online.

If paying online, please write down the total amount due because you will need to enter it again to complete the transaction.

Please make your check payable to MAGPS and mail your payment to:

Deborah M. Sinek, Ph.D. 313 2ND ST SE STE 211 CHARLOTTESVILLE VA 22902-5686

Cancellation Policy: Full refund less $25 if cancelled by April 16, 2010. No refunds after this date.

Payment Choice?

I'll mail in my check

I'll pay online

Name

Street Address

City, State, Zip

Is this a change of address?

No

Yes

Phone Number (xxx-xxx-xxxx)

E-mail address

Specify small group leader preferences

Choose for me

See my ranking below

1=first choice, 2=second choice, 3=third choice, etc.

Beller

Brandel

Casey

Cordonnier

Gump

Hafkin

Hawkins

Hedlund & Stillerman

Lovett & Lovett

Riddell

I am willing to be a Mentor

Yes

No

If needed

Space for Messages or Special Needs