Missouri Public Health Association
722 E. Capitol Avenue
Jefferson City, MO 65101
573-634-7977

Conference Registration

Company Information

Contact Name: * Organization: Address Address 2 City

State Zip

Email *

Phone Fax

	Before 9/15	After 9/15
Pre-Conference - Tuesday (9/24)	$75	$100
Member - Two Days (9/25-26)	$175	$200
Member - Wednesday	$100	$125
Member - Thursday	$100	$125
Non-Member - Two Days (9/25-26)	$325	$350
Non-Member - Wednesday	$175	$225
Non-Member - Thursday	$175	$225
Full Time Student - Both Days	$70*	$70*
Full Time Student - Wednesday Only	$35	$35
Full Time Student - Thursday Only	$35	$35
Retiree - Two Days (must be retired)	$75	$100
*Must be a FULL-TIME student currently enrolled in a Missouri Institution of higher education

MOPHA | Conference Registration Form