Conference Registration Form

REGISTRATION	PRICE
Early Bird Deadline: Wednesday, March 14th, 2012	$329 MRA Members $379 Non-Members
Regular Deadline: Wednesday, March 28th, 2012	$379 MRA Members $429 Non-Members
Late/On-Site (After March 28th)	$399 MRA Members $429 Non-Members
Reception Only	$125 (All)

Registration and payment must be received by deadline at 5:00pm MST.
Cancellation policy - A cancellation fee of $25 will be applied.
No refund will be issued after registration cut-off March 28^th.

STEP 1 - Add Attendee(s)

Name as you would like it to appear on badge

Registration Type

Select Registration Type

MRA Chapter Membership

Select Nonmember Atlanta/Southeast Chicago Florida Great Lakes Greater New York Mid-Atlantic Minnesota/Upper Midwest New England North West Philadelphia Southern California Southwest

STEP 3 - Add Company Information

Company Name
Address
City	State	ZIP
	Select Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut Canal Zone DC Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mariana Islands Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming

Phone	Fax	Email

All Early Bird Registrants will be entered into a drawing for a chance to WIN
a 2012 SWMRA Educational Forum Registration.

Register Early at the Planet Hollywood, 877-244-9474, and receive the conference room rate of $99 per night.
Use Room Code SMSMR2.

Rates good through March 14^th, or until the room block is full.