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Maca Register Test
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Maca Register Test
View the 2019 Annual Registration Brochure
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PAGE 5
2019 Annual Meeting Registration Form
* Required Field
1. YOUR INFORMATION
Name
*
First
Last
Name for Badge
*
Spouse's Name
Spouse's Name for Badge
Company Name for Badge
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
*
Email
*
2. RECEPTION INFORMATION
Will this be your first time attending?
Will this be your first time attending?
First Time Attendee
Tuesday Evening Reception
0
1
2
Thursday Breakfast
0
1
2
Additional Requests or Comments
3. REGISTRATION FEE
Includes all MACA meals and programs (except athletic events), but does not include hotel room. The fee is based on the date the payment is postmarked. Resubmit this form for additional registrations.
Member (Individuals) - $545.00 (Aug. 13 - $575.00)
Quantity
Price:
$575.00
Quantity
Members (Couples) - $575.00 (Aug. 13 - $605.00)
Quantity
Price:
$605.00
Quantity
Non-Members (Individuals) - $850.00 (Aug. 13 - $880.00)
Quantity
Price:
$880.00
Quantity
Non-Members (Couples) - $900.00 (Aug. 13 - $930.00)
Quantity
Price:
$930.00
Quantity
4. SPECIAL EVENTS
A. Industry Tour - Tri-Rinse Tour & Lunch (payment required)
$110.00 - 1 Attendee (Aug. 13 - $140.00)
$220.00 - 2 Attendees (Aug. 13 - $280.00)
Please Choose
1 Attendee Industry Tour and Lunch
2 Attendees Industry Tour and Lunch
Name of first attendee for the Tri-Rinse Tour & Lunch
Name of second attendee for the Tri-Rinse Tour & Lunch
B. Service Project - Operation Food Search (no payment)
No Charge - Please Register
Please Choose
1 Attendee
2 Attendees
5. GOLF FEE
Number of players you will be registering. (payment required)
Please Choose
1 Player - $110.00 (Aug. 13 - $140.00)
2 Players - $220.00 (Aug. 13 - $280.00)
3 Players - $330.00 (Aug. 13 - $420.00)
4 Players - $440.00 (Aug. 13 - $560.00)
5 Players - $550.00 (Aug. 13 - $700.00)
6 Players - $660.00 (Aug. 13 - $840.00)
6. GOLF REGISTRATION
List the golfers you are paying for — be sure to include yourself!
Golf 1 Name
Golf 1 Company
Golf 2 Name
Golf 2 Company
Golf 3 Name
Golf 3 Company
Golf 4 Name
Golf 4 Company
Golf 5 Name
Golf 5 Company
Golf 6 Name
Golf 6 Company
YOUR TOTAL
$0.00
Are you human?
By sending this form, I agree to have this website store my submitted information so they can respond to my inquiry.
*
I Agree
ADDITIONAL INFORMATION
Pay securely with debit or credit card by clicking the PayPal button below.
PayPal account is not required to make payment.
* REFUND POLICY: Any Refund request must be made in writing and submitted to the MACA office by August 26, 2022. NO REFUNDS after August 27, 2022.
Scholarship
Education
Agriculture Academy Website
Teacher Resources
Developing Professionals
Mini-Bulk Containers
Pesticide Disposition Flow Chart
Membership
Info
Issues
Affiliate Organizations
2023-2024 Officers & Board of Directors
Members Only
Waste Management
Literature
Hazmat Video Page
Get Access to Hazmat Videos
Member Directory
Issues Review
Contact
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