This is only the pre-registration form for the MS Literacy Association: Winter Literacy Conference!
You are not registered for the event by completing this form. You must take the access code you are provided after submission and fully register for the event at the MS RESA website. Details on how to complete the registration (including the access code) will be emailed to you immediately after this form is submitted.

Participant Information

Name

First Last

Email*

Cell Phone*

Current School District*

If you are a student or with an organization other than a school district, please enter the name of the school or organization.

Will you be attending the free-of-charge lunch provided on Thursday, December 2?*

If you have any food allergies (nuts, dairy, etc), please list them below.

Will you be attending the free-of-charge brunch provided on Friday, December 3?*

If you have any food allergies (nuts, dairy, etc), please list them below.

Registration Type*

Upload Current Undergraduate Student ID*

Early Registration Payment Method

If you select the credit/debit card option, there will be a small fee added the conference fee total to cover our usage charge.

Student Registration Payment Method

If you select the credit/debit card option, there will be a small fee added the conference fee total to cover our usage charge.

Early Registration Agreement*

I understand and agree that if I do not complete my registration by November 10, I will be responsible for an additional $50 of the Late Registration.
I understand and agree that if I am paying for this registration with a district purchase order, the registration must be completed before November 10, even if the purchase order is not received by then. All purchase orders must be emailed to bstew@olemiss.edu.
I understand and agree that if my credit/debt card or check/money order payment is not received by November 30, my registration will be canceled. This does not include those individuals who are paying with a purchase order.
I understand and agree that if I do not cancel my registration before 11:59PM on November 30, I will be marked as a No Show and will still be responsible for paying the registration fee even if I do not attend the conference.

Student Registration Agreement*

I understand and agree that if I am unable to provide a valid student ID for the student registration, I will be responsible for the additional $100 of the Early Registration fee.
I understand and agree that if my credit/debt card or check/money order payment is not received by November 30, my registration will be canceled.
I understand and agree that if I do not cancel my registration before 11:59PM on November 30, I will be marked as a No Show and will still be responsible for paying the registration fee even if I do not attend the conference.