A-MSA | Alabama-Mississippi Sociological Association

Annual Meeting Registration

**You will be directed on how to pay by CHECK or PAYPAL after submitting your registration.**

REGISTRATION FORM


First Name:
Middle Name:	Name Tag:
Last Name:
Affiliation:
(if "Other"):	Phone #:
Street Address:	Fax #:
City:
State:	E-Mail:
Zip Code:	Verify E-Mail:


Current AMSA Membership Status:

Are you a first-time AMSA attendee?		YesNo

Would you be willing to chair an AMSA conference session?		YesNo

Would you like to make a tax deductible donation to the AMSA?		YesNo
amount:

Do you have any food allergies or dietary needs that require special meals?		YesNo
If so, please explain:

		Quantity	Amount	Total
Membership Dues
	Faculty/Staff		20.00
	Student		$5.00
Annual Meeting - Registration
	Faculty/Staff		$25.00
	Student		$5.00
	Non-Member		$45.00
Annual Meeting - Banquet
	Faculty/Staff		$25.00
	Student		$15.00
	Guest		$25.00
	Non-Member		$25.00

	TOTAL AMOUNT DUE: