Registration Form – Healthy MS Conference

Register for 2023 Mississippi Healthy Workplace Healthy Communities Conference

Name *

First

Last

Company Name *

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Credentials

Title/Position

Address *

Address Line 1

City

State

Zip Code

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Email *

Phone *

Emergency Contact Information

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Name *

Phone *

Conference and Pre-/Post-Conference Course Cancellations and Changes

Cancellation requests must be received in writing on or before March April 1, 2023. For conference registrations, a refund will be issued minus an administrative fee of $25.00. Substitution requests must be submitted in writing.

Agreement *

I have read and understand the above Pre-Conference and Conference Cancellations/Changes policy.

Registrations received without payment will not be processed and no refunds available.

Early Bird Payment Options

Individual Registration - $ 25.00
State Employee Wellness Champion - $ 0.00

Select Exhibit/Sponsorship

Not-for-Profit Exhibitor - $ 100.00
Exhibitor Booth - $ 500.00
Event Sponsor – Booth and Into Session - $ 1,000.00
Premier Sponsor – Booth, Welcome and Lunch - $ 2,500.00

Stripe Credit Card

Card

Name on Card

Total

$ 0.00