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Midwestern States Environmental Consultants Association   

Soil Gas Virtual Meeting
Registration Form

Company

Consultant Member Registration

If your company is currently a Consultant Member of MSECA,
please select it from the list below.

Consultant Member Company

Non-Member Registration

If your company is not currently a Consultant Member of MSECA,
or is not listed on the above drop down,
please provide the following information:

Company

Would you like us to follow up with you on joining MSECA or renewing your MSECA Membership so you can receive the Member rate?

Yes          No

Registration Category

How many people will be attending from your company?*

  Individual Attendee
(MSECA Member - $25.00 | Non-Member - $50.00)

  Up to 4 Attendees
(MSECA Member Only - $50.00)

  Up to 7 Attendees
(MSECA Member Only - $75.00)

  Unlimited Attendees
(MSECA Member Only - $100.00)

Individual Attendee or Primary Contact

For company registrations, MSECA will follow up with the primary contact for a list of your company's attendees.

Name*

Email Address*

Payment Options

Payment Type*

Check           Credit Card (Visa, Mastercard, & Discover)

Email Address to Invoice*

If you select to pay by credit card, an electronic invoice will be sent to the address above from our credit card processor (Authorize.net) with a link to pay securely online.

If you select to pay by check, we'll email you an invoice to return with your payment.

Thank You for Your Support of MSECA

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