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Midwestern States Environmental Consultants Association   

MSECA Virtual Meeting
Registration Form

Company

Member Registration

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

Member Company

Non-Member Registration

If your company is not currently a 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 - $150.00)

  Up to 4 Attendees
(MSECA Member - $50.00 | Non-Member - $275.00)

  Up to 9 Attendees
(MSECA Member - $75.00 | Non-Member - $375.00)

  Unlimited Attendees
(MSECA Member - $100.00 | Non-Member - $450.00)

Primary Contact

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

Name*

Email Address*

If you've selected "Unlimited Attendees" we'll provide a link so anyone from your company can sign-up without having to go through the primary contact.

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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