Name:____________________________________________________________
Organization:______________________________________________________
Address:__________________________________________________________
_________________________________________________________________
Phone Number:_____________________________________________________
Email Address:______________________________________________________
To assist in room scheduling for the
break-out sessions, please indicate which programs you anticipate
attending:
|
9:00 |
10:00 |
|
__ Option 1 |
__ Option 1 |
|
__ Option 2 |
__ Option 2 |
|
__ Option 3 |
__ Option 3 |
|
__ Option 4 |
__ Option 4 |
|
__ Option 5 |
|
REGISTRATION
DEADLINE: October 17, 2008
Attendee
Name:
Name as it appears on credit card:_____________________________________
Billing Address:
_____Visa
_____Mastercard
Account Number:___________________________________________________
Expiration Date:____________________________________________________
Security
Code (3 digit number on back of card):
Signature:_________________________________________________________
___Check Enclosed (MAPGC Member: $40; MAPGC Non-Member: $65)
 |
Please
make check payable to
Mid-America Planned Giving Council and mail with registration
form to:
Lin Dunlap, Administrator
Mid-America Planned Giving Council
13-A NW Barry Rd., #213
Kansas City, MO 64155-2728
Phone: (816) 468-0791 |
