Author: BJ

MALA 2017 Fall Conference Camden on the Lake, Lake Ozark, MO October 8-10, 2017

ACCOMMODATIONS: MALA has negotiated room rates starting at $109 per night up to $144 per night (plus tax). This price is guaranteed through September 15, 2017. After September 15, these rates are subject to room availability. For reservations, call (888) 365-5620 and mention MALA 1017 for the conference group rate.

ATTENDEE REGISTRATION FORM
Limit 3 attendees per form, submit additional forms as needed. Print names and titles as they should appear on the name tag. Take $50 off the price for the third registration. This offer does not apply to MALA Corporate members.
If you want to confirm your registration for the conference, please e-mail cindy@malarcf.org or keith@malarcf.org or contact our office.
Name (Attendee 1): _____________________________________ Title: __________________________ LNHA/RCAL #: ___________
Name (Attendee 2): _____________________________________ Title: __________________________LNHA/RCAL #: ___________
Name (Attendee 3): _____________________________________ Title: __________________________LNHA/RCAL #: ___________
Facility Name: _________________________________________________________________ Region __________
MALA Member: YES or NO (please circle) Special diet: yes (Type)____________
Phone: __________________________ Fax: _______________________ Email: ____________________________________________

Members are required to designate one voting representative for the annual membership meeting. MALA Corporate Members will be contacted to designate one voting representative.
(«) VOTING REPRESENTATIVE - CIRCLE ONLY ONE: Attendee 1 Attendee 2 Attendee 3

Are any of the registrants attending the MALA conference for the first time? If so, circle which attendee(s):
1 2 3

Are you a MALA Corporate Member? (Bristol Care, Inc; Americare, Inc; Care Network, Community Residence, Inc. or other) Corporate Members receive one complimentary attendee registration for each paid registration.
Meals must be purchased for the complimentary registrants. See Guest Meal Package section below.

Full Conference Registration Prices Includes all meals, sessions and admittance to exhibit hall on Monday.

Registration Prices:	Early Bird (by 9/10/17)	Regular (by 9/24/17)	Late / (After 9/24/17)	Discount / $50 off 3rd registration	Total
Member	$295	$325	$400
Non-Member	$395	$425	$500
See the reverse side of this form to RSVP for the Sunday, October 8th Celebration Boat Cruise. / Due to limited space; this is offered to only registered conference attendees.

Single Day Registration (no discounts) Includes meals, sessions and exhibit hall on Monday.

Check One:	Member	Non-Member	Total
Sunday	$100	$200
Monday	$200	$300
Tuesday	$165	$265

GUEST and COMPLIMENTARY CORPORATE MEAL PACKAGES	Price	Qty	Total
Monday - Breakfast and Lunch	$50
Tuesday - Breakfast and Lunch	$50

PAYMENT METHOD:
___Check (Payable to MALA) ____MasterCard ____Visa ____Discover ____ American Express
Credit Card #:__________________________________________ Exp: MM_____ YY______
Three digit security code: (back of card) ________________
Cardholder Signature: ______________________________________________________

GRAND TOTAL
$

All Registration Forms must be signed
Signature:_________________________________________ Date: ____________
Registration is NOT complete until payment is received.
Mail this form with payment to: Credit card payments: Missouri Assisted Living Association Fax: (573) 634-7344 2407B Hyde Park Road Questions: Jefferson City, MO 65109 Call: (573) 635-8750

Early Bird Registrations must be postmarked by September 10 to receive the discounted rate and to be entered into the Early Bird Drawing.
CANCELLATION POLICY: Refunds will be given, less a $50 administrative fee, for written cancellations received on or before 09/25/2017. Such refunds will be issued following conference. No refunds will be given after September 25, 2017
No refunds given after October 1. (no exceptions).

Name (Attendee 1): __________________________________________ YES r NO r
E-mail address: ______________________________________
Name (Attendee 2): __________________________________________ YES r NO r
E-mail address: ______________________________________
Name (Attendee 3): __________________________________________ YES r NO r
E-mail address: ______________________________________
(RSVPs must match the Registration Form)
*In the event we receive 125 reservations and your registration is received after maximum
capacity is fulfilled, you will be place on a waiting list and notified via email of any cancelations.

Will you be joining us for a Lake Cruise on Sunday, October 8th??
(5:30 to 8:30)
Due to the ship’s maximum occupancy, reservations are limited to
the first 125 conference attendees.