HMA CONFERENCE 2001
UNDERSTANDING
HEALTH MINISTRIES

AWAKEN TO THE CALL

Membership Information

HMA Member YES___ NO___

Chapter Name _____________________________________

State ____________________________________________

Personal Information (Please Print)

First Name________________ Last___________________

Nickname (for badge)____________________

Title____________________________

Employer/Organization_________________________

Address________________________

City________________ State_____ Zip+4_______________

Home Phone_______________ Work Phone_____________

Fax_________________ E-Mail_______________________

Special Needs

__Check here if you have a disability and may require accommodations to fully participate. Please attach a written description of your needs. You will be contacted by HMA.

Registration Fees (Check Appropriate Category)

  EARLY REG
By April 22
  LATE REG
After April 22

 
Member Non-member* Member Non-member*
Pre-Conference Full $115 $165 $140 $190
Pre-Conf. Commuter $90 $140 $115 $165
Full Conference $350 $400 $375 $425
Commuter $240 $290 $265

$315

Daily Fee $125 $175 $150 $200

*Non-member fee includes membership if desired: Yes No

Key Note Speaker:
I ndicate Number of Ben Carson Tickets__________
Dr. Ben Carson __$30 Student/College__ $20 Youth __$15
T uesday Evening Event only __$25
F ull convention and commuter registration fees include
keynote and Tuesday evening event

Daily Registrants Check the day(s) you will be attending:

Tuesday 6/19__ Wednesday 6/20__

TOTAL ENCLOSED____________________

ROOMS are double occupancy and included in the full fee.
If no roommate is requested one will be assigned.
Roommate: _________________________
Additional fee for single room:

PRE-CONFERENCE: $10 CONFERENCE: $30
Additional Guest $ 40.00 per night Room & Board only

    REGISTRATION FORM

    Early Registration Deadline: April 22, 2001
    HOW TO REGISTER

  • Fill out registration form below. Mail to the address indicated. Do not mail to HMA.
  • Registration Deadline: Monday June 11, 2000
  • Registrations will be accepted after the deadline if space permits

Seminar Choices

Registration is required for all program sessions. Space is limited. If a session becomes closed, HMA will place you in your second choice as long as it is available. Please indicate your first and second choices by writing in the code listed before the session title.

Pre-Conference & Conference Choices

(Indicate 1st & 2nd Choices)

Monday, June 18 Pre-Conference

(one full day or two half day)

1st Choice _____________________________

2nd Choice _____________________________

Tuesday, June 19 Conference

(1 Workshop, 1 Seminar, OR 2 Papers per time)

11:30-12:30PM 1st________________________

2nd Choice______________________________

3:00-4:00PM 1st__________________________

2nd Choice______________________________

Wednesday, June 20 Conference

(1 Workshop, 1 Seminar, OR 2 Papers per time)

9:00-10:00AM 1st________________________

2nd Choice_____________________________

10:30-11:30AM 1st_______________________

2nd Choice_____________________________

Method of Payment

Conference Participant's Mailing Lists will be available during the conference. If you would like to be excluded from this mailing list, please check below. __Exclude my information from the mailing list

  • Check/money order payable to HMA

Mail completed registration form to:
HMA
2001
Convention %Rick Parker
PO Box 199
A lexandria, KY 41001

Questions: CALL 859-292-4149 or email to rparker@stelizabeth.com

Cancellation Policy
To be eligible for a refund, cancellations must be received NO LATER THAN JUNE 4, 2001. An administrative fee of $50 will be charged for all refunds. All refunds will be processed after the convention. HMA will not refund fees solely based on program changes. Substitutions are welcome, upon written notification to registrar.