OFFICIAL REGISTRATION FORM

Name:____________________________ Date:___________________

Address:___________________________________________________

City:_________________ State____ Zip Code____________

Phone #:________________________

Email Address:____________________________________________

Members and Guests Attending

Title                 Name             Det. Name/# or MCLA or Guest      Arriving?

____  _________________ __________________________      Fri/Sat

____  _________________ __________________________      Fri/Sat

____  _________________ __________________________      Fri/Sat

MCL Member/MCLA Registration __ x $ 5.00 = ________

Banquet Saturday Night, May 1st   __ x $40.00 =_________        

                                      Total Payment   $_______________

(Meal is $40.00 per person) Please check your meal choice:

(Chicken Marsala) X______               (Rib Eye Steak) X______ ______________________________________________________________________________  Please return this form and make check or money order payable to “MCL Dept.of Mississippi”    

by April 10th, 2010 to:

James (Wes) Hill, Adj/Paymaster, Dept of MS

876 Toccopola Junction Rd

Thaxton, MS 38871

For help or additional information, contact Wes Hill at 662-234-5244/e-mail: jwhill2@wildblue.net; or Patrick Tutor at 662-489-8825; or Rex Moody at 662-790-4476. We will send you an e-mail (or postcard) to confirm your banquet reservation.