General Registrations – Healthy MS Conference

Register for the 2025 ECHMC

Join Our Mission for A Healthy MS!

Name *

First

Last

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Credentials (if applicable)

Name as you wish to see it printed on badge

Company Name

Address *

Address Line 1

City

State

Zip Code

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Email *

T-Shirt Size *

Phone *

Registration Type *

Emergency Contact Information

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Name *

Phone *

Conference Cancellation/Change Policy

Cancellation requests must be received in writing on or before May 1, 2025. The committee may issue a refund for conference registrations at its discretion.

However, if you cannot attend, someone from your organization may participate in your place. Cancellation and substitution requests must be submitted and confirmed via email to info@healthymsconference.com

Hotel cancellation policies are at the discretion of the hotel and apply separately.

Agreement *

I have read and accept the Conference Cancellations/Changes policy above.

Registrations received without payment will not be processed.

Questions? Please Email info@healthymsconference.com

Payment Options *

Online Registration - $ 50.00
By Mail Registration (please print and send this form along with payment to Mississippi State Department of Health, Office of Preventive Health, C/O Charlotte Holly P.O. Box 1700, Jackson, MS 39216) - $ 50.00

*ECHMC is a not-for-profit/non-income event. All funds collected go directly toward conference operational costs. Forms and payments sent by mail must be received by April 15, 2025. Thank you for supporting our mission.

Stripe Credit Card

Card

Name on Card

If you are paying by mail, please select the By Mail payment option above and bypass the Credit Card area. Registration will not be accepted if you select Online payment and do not enter your credit/debit card information. If you have any issues or questions, please email the conference planner at info@healthymsconference.com or call 228-326-0824.

Total

$ 0.00