Vendor Registration – Healthy MS Conference

Exhibitor/Vendor Registration

Join Our Mission for A Healthy MS!

Name *

First

Last

Organization/Business *

Address *

Address Line 1

City

State

Zip Code

Layout

Phone *

Website

Email *

Name of Person Attending Conference *

First

Last

Name of 2nd Person Attending Conference (if applicable)

First

Last

Upload Company Logo

Click or drag a file to this area to upload.

Select Exhibitor/Vendor Type *

Exhibitor (No Items Sold) - $ 250.00
Vendor (Selling Items) - $ 250.00

Please describe the type of goods/services you will provide at the event. *

Select Payment Option *

Online - please enter credit card info and submit through stripe below
By Mail - 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 39216-1700

*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