Untitled Document

Conference Registration Form

MMABSE
2007 Fall Conference
October 24-25, 2007

Clarion Hotel and Convention Center
5311 South Howell Avenue
Milwaukee, Wisconsin

Name:
Address:
City:
State:
Zip:
Telephone:
E-Mail:
School/Organization:

Pick one
Current Educator:
Retired Educator:
Years of Service:
Position:
Date of Retirement:
Please check box for Meal Preference	Vegan Non-Vegan

Conference Registration Fees:
Pre- Registration (by September 29, 2006)	$ 85.00
On-site Registration (Post marked after September 29, 2006)	$ 95.00
Undergraduate Student / Retiree	$ 30.00
Sub Total Amount:

Membership Dues:
Annual/ Retired	$25
Undergraduate Student	$10
Sub Total Amount:
Donation: Burns-Starms Scholarship Fund
Total:

Please make checks payable to MMABSE and send to MMABSE, P.O. Box 2132, Milwaukee, WI 53202-2132. THANK YOU.

Metropolitan Milwaukee Alliance of Black School Educators
Post Office Box 2132
Milwaukee, Wisconsin 53201-2132