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Mississippi Conference on Church Music and Liturgy

2017 Online Registration Form

 Please return this form with the deposit of $100 By July 12, 2017

       (or the total fee of $675 or $385 as noted in fees section)ees section)ees section)

       Make checks payable to: Mississippi Conference on Church Music & Liturgy

Payment by cash or check only; no payment by credit card available.

       To:    Dr. Mark Butler
                987 Knollwood Drive
                Dunedin, FL 34698

Personal Information

Name (Mr. Mrs. Ms. Rev. Dr. other_____):  
Address:
Address2:
City: State: Zip:
Phone: Email:
Voice Part:
 
Church Information
Church: Church:
Diocese: Position:
 
Fees and Other Conference Details

Full Conference $675

_________

Total Amount Due: 

_________

Weekend Conference Only $385

_________

Amount of Deposit:

_________
Private Room Add $125 ($50 Weekend) _________

 

 

Note: Private rooms are available for an additional fee in the order that registration deposits are received.

The conference reserves the right to limit the number of private rooms if needed to accommodate housing

needs of all participants.

Room Preference:

Inn

Cottage

 
Roommate Preference:
Name for the name tag:
First Time to Attend?

Yes

No

 
Scholarship Assistance

I am requesting a

Diocesan Scholarship

(For MS Residents Only)
Full Conference   (Worth $330) Weekend (Worth $165)

I am requesting the

"18 to 30" Scholarship

(Please Supply a Letter from Rector)
Full Conference or Weekend ($300 Applied to Fee for Either)
 
For Other Information
Write:   Mississippi Conference

            5400 Old Canton Rd.

            Jackson, MS 39211