MITAS 2019 User Conference
April 7-9, 2019

The Mitas Group
MITAS 2019 User Conference Registration

The Registration fee is $495 for each attendee. Conference registration closes March 7, 2019.

Guest Registration fee is $200. Paid guest registration includes Sunday's Welcome Reception and Monday night dinner.

Please complete the following information for each conference attendee. If needed, please submit multiple registration forms for your agency.

Once we have received your registration, your agency will be billed for each attendee registered. If you would like to pay by credit card, please contact Sherrie Mitas at (800)-814-6482.

Agency Name:

Contact Name for Registration Questions:

Phone Number:

Email Address:

Mailing Address:

City:

State:

Zip-Code:


Attendee 1

First & Last Name:

Current Position:

Phone:

Emergency Contact First & Last Name:

Emergency Contact Phone Number:

Guest's First & Last Name:

Special Diet or Food Allergies. Please list for you and your guest:

Early Departure Tuesday. Please list departure time:

Special Notes and Remarks:


Attendee 2

First & Last Name:

Current Position:

Phone:

Emergency Contact First & Last Name:

Emergency Contact Phone Number:

Guest's First & Last Name:

Special Diet or Food Allergies. Please list for you and your guest:

Early Departure Tuesday. Please list departure time:

Special Notes and Remarks:


Attendee 3

First & Last Name:

Current Position:

Phone:

Emergency Contact First & Last Name:

Emergency Contact Phone Number:

Guest's First & Last Name:

Special Diet or Food Allergies. Please list for you and your guest:

Early Departure Tuesday. Please list departure time:

Special Notes and Remarks:


Attendee 4

First & Last Name:

Current Position:

Phone:

Emergency Contact First & Last Name:

Emergency Contact Phone Number:

Guest's First & Last Name:

Special Diet or Food Allergies. Please list for you and your guest:

Early Departure Tuesday. Please list departure time:

Special Notes and Remarks:


Attendee 5

First & Last Name:

Current Position:

Phone:

Emergency Contact First & Last Name:

Emergency Contact Phone Number:

Guest's First & Last Name:

Special Diet or Food Allergies. Please list for you and your guest:

Early Departure Tuesday. Please list departure time:

Special Notes and Remarks:


Submit

If you need to register for more than 5 attendees, please refill out and submit the registration form.
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