SUMMER CONFERENCE REGISTRATION 2024

NMJOA

2024 Summer Conference
September 11-13, 2024

5780 Shanty Creek Road
Bellaire, MI 49615

***Guests must make their own separate room reservations***

HOTEL BOOKING LINK (must be completed and emailed or faxed to Shanty Creek Resort)

Conference Agenda Link

If you have any questions about registration please contact Kevin Mitchell at 734-320-0330 or mitchellk@washtenaw.org

Questions pertaining to payment can be referred to Linda Strasz at 989-672-3859 or lstrasz@tuscolacounty.org

DEADLINE TO REGISTER FOR THE CONFERENCE AND BOOK YOUR HOTEL IS AUGUST 3, 2024.

CONFERENCE REGISTRATION:

County/Agency*

Professional Membership*

GUEST 1 INFORMATION

PLEASE NOTE: Copy of completed Registration Form will be sent to email address listed for Guest 1

Full Name*

First NameLast Name

Title/Position

E-mail*

Registration confirmation/invoice will be sent to this email address upon submission of this form

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 1 Registration Fees

Add another guest?

YesNo

Full Name

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 2 Registration Fees

Add another guest?

YesNo

GUEST 3 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 3 Registration Fees

Add another guest?

YesNo

GUEST 4 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 4 Registration Fees

Add another guest?

YesNo

GUEST 5 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 5 Registration Fees

Add another guest?

YesNo

GUEST 6 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 6 Registration Fees

Add another guest?

YesNo

GUEST 7 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 7 Registration Fees

Add another guest?

YesNo

GUEST 8 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 8 Registration Fees

Add another guest?

YesNo

GUEST 9 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 9 Registration Fees

Add another guest?

YesNo

GUEST 10 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 10 Registration Fees

Add another guest?

YesNo

GUEST 11 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 11 Registration Fees

Add another guest?

YesNo

GUEST 12 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 12 Registration Fees

Add another guest?

YesNo

GUEST 13 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 13 Registration Fees

Add another guest?

YesNo

GUEST 14 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 14 Registration Fees

Add another guest?

YesNo

GUEST 15 INFORMATION

Full Name*

First NameLast Name

Title/Position

E-mail

Vegetarian meals required?*

YesNo

Spouse meal required?*

YesNo

T-shirt Size*

Guest 15 Registration Fees

Total Registration Fees

Payment Options:

Payments may be made via credit or debit card and submitted with this registration form.

PLEASE NOTE: THOSE SELECTING TO PAY BY CHECK CAN SEND THEIR PAYMENT TO:

JJAM
440 N. STATE STREET, CARO, MI 48723

Form of Payment

Credit/Debit CardCheck

Please select the correct quantity of guests below before completing your payment. ________________________________________________________________________

Individual Guest Registration Fee$125.00

Quantity
Item subtotal:$0.00

Total $0.00

Credit Card