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MACAA 2012 Retreat Registration
Hannibal Arts Council Volunteer Opportunities Survey
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MACAA 2012 Retreat Registration

Please submit your registration below.  
Name:
Email address (will not be published):
Comments:
Your Agency:


Name of Attendee

(Please add additional names below) (required)
Postal Address

Address ( required )

Address 2
  
City, State, Zip ( required )
U.S. Mailing Address (required)
Phone Number
 
U.S. Phone number (required)
Email Address

Email address (you@yourdomain.com)
MACAA Member Registration Fees:

Select one: (Not sure you're a current MACAA Member? Call Kerrie Green Otten at 573-221-4853)
Non-member Registration Fees

Select one:
Total Amount due for registration(s)

Please include total amount of check you are mailing for all registration(s). Mail check to MACAA, PO Box 1202, Hannibal, MO 63401. (required)
Additional Attendees and/or Requests

Please list any additional attendees, not listed above. Please also let us know if you have any dietary restrictions or special requests.
To be considered for a scholarship, please apply by February 17.



Check the option from the list that is appropriate. Do not send payment, the MACAA office will notify you regarding your scholarship request. Please note that we only have a limited number of scholarships.




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