Please make your selection and return this form no later than May 15th, 2023, along with your
check made payable to:

Mississippi State Department of Health Office of Preventive Health, C/O Charlotte Holly,  P.O. Box 1700, Jackson, MS 39216-1700

CONTACT US: Phone 877-673-2462 • Fax 877-673-2462 • Email • Website

Click or drag a file to this area to upload.
We must receive all payments and forms in the mail by April 15th.
If you are a FREE VENDOR - please bypass the Credit Card area. If you are a Paid VENDOR and do not pay by credit card during registration, your registration will not be accepted. If you have any issues, please contact the conference planner with any questions at or call 1-877-67-ECHMC
$ 0.00