Name              :       
Title:                        

Group:   Yes   Number:    Please send separate form for each person.  (See group rate below).

Organization/Institute:                         

Address:       City    
                     State         Zip  

Phone:          Work         Cell  

Email:          

All meals vegetarian?      Yes        No
To help us plan food and costs, which days are you planning to attend?   Sun, 10/5     Mon, 10/6    Tues, 10/7 

  Please CHECK if you will participate in the tour of Mississippi Gulf Coast Community College and Pearl River Community College.

Register for Sunday's Pre-Conference Sessions:  Please mark if attending.
   Pre-Conference Session #1 TBA
   Pre-Conference Session #2 TBA

Fees:  (Registration fees include Sunday's reception, Monday breakfast, lunch, tour of two MS Community Colleges on or near the Mississippi Gulf Coast, dinner and Tuesday's breakfast.).

Select a Fee Schedule Below Individual - Early Bird Rate if postmarked by July 31, 2008 .... $325 Individual Fee - August 1-September 14, 2008 .... $375 Groups of 3 or more if postmarked by July 31, 2008 .... $300 per attendee Groups of 3 or more from August 1-September 14, 2008 .... $350 per attendee Student Fee .... $175 Participating guest/partner/spouse fee .... $175

    Please send a separate registration page for the guest/partner/spouse
    Registrations received after September 14 are accepted with an additional $40 surcharge
    Cancellation Guidelines:  Full refunds are given before August 20, 2008

Hotel:
Beau Rivage rooms and special rate guaranteed until September 24, 2008; please make reservations directly with the Resort at 888-567-6667 and identify affiliation with the Rural Community College Alliance.

Payment Method:

Credit Card Type:      Please select a credit card type below Visa Master Card
Card Number:          
Expiration:                 Month:     Year: 
Name on Card: