2004 Missouri State Music Teachers Mini-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, $25.00

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

Tickets for Saturday Evening Meal (18% gratuity included):
___ Lemon Peppered Chicken, $16.50
___ Beef Tenderloin Filet, $22.50
___ Vegetarian, $12.00

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.