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Friday, September 21, 2018
PRE-REGISTRATION FORM
Mid-Year Convention Pre-registration Form

SEND TO:
Mississippi Moose Association
7930 Country Place Drive
Meridian, MS 39307

Mid-Year Convention March 21 -24, 2019
Best Western-Seaway Inn, GULFPORT MS.
Must be received by March 10, 2019
Please use 1 form per person

Information:
Name:________________________________________
Address: _____________________________________
City/Zip:______________________________________
Phone #: _____________________________________
Lodge:________________________________________
Office/Title:_____________________________________
Guest Name ___________________________________
Check One: [ ] LOOM [ ] Moose Legion
[ ] Fellow [ ] Pilgrim

Items: Please check the items wanted and enter amount Amount:
Registration: [ ] Men $25.00 ____________________
[ ] Guest $30.00[non Moose member] ____________________
[ ] Guest $5.00 [under 21 ____________________

Total Money Sent ____ ________________

All guests who will be attending functions such as Hospitality Room or Banquet must be registered with nametag. There is a $30.00 charge for persons over 21 and a $5.00 charge for persons under 21.


E-Mail______________________________________________

MMA Form 6 (December 2013)











Thursday, January 25, 2018
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