2005 Missouri State Music Teachers Conference
Pre-Registration Form
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Copy and paste this form into a word processor, type 
in the necessary information, and print.

Name, address, city, state, zip:


Phone:

Email:

Indicate number desired of each item below:

___ Registration fee, $30.00

___ Student (No registration fee is required, but please register!)

___ Friday lunch - $11.00 Chef Salad Bar with Soup and Dessert (Student members are invited to this luncheon as guests of MMTA)

___ Saturday lunch - $15.00 Chicken Dijon with Wild Rice and Snow Peas; Salda and Dessert. Vegetarian available with 2 weeks prior notice. Contct Janice Wenger 573-882-0932 or email wengerj@missouri.edu

Foundation Raffle Tickets:
___ 1@$5.00
___ 6@$25.00



Make checks payable to MMTA.  

Please include this form with ***explicit instructions for what the check covers***. 

Mail this completed form and check to: Carol 
Borgstadt, 29327 Highway PP, Concordia, MO 64020.

Pre-registration Deadline is October 24, 2005.