Missouri Annual Conference Registration

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					                                       Missouri Annual Conference Registration
                                             June 8th - June 11th, 2012
            Each person must register on a separate form (visitors do not register). Please go to
     www.moumethodist.org/ac12 to register online, then pay at the end of the online registration with
  credit/debit card or mail in your check to the Conference Office. Mail-in registrations should include all
    necessary forms and a check payment made out to “Missouri Annual Conference”. Fees will NOT be

     Name: _______________________________Name for Tag: ________________________
    The Values Monitoring team is requesting this voluntary information as we are working for greater
inclusiveness and partnership to bring about full and equal participation in the total life and mission of the
       Gender: □ female □                        male      Ethnicity: □ African American/Black                                     □ Asian □Native American
                                       □Hispanic           □White □Other Age: □ 10-19 □ 20-29                                       □ 30-39
                             □ 40-49 □ 50-59 □ 60-69 □ 70-79 □ 80-89 □ 90-99 □ 100 and over
                                                                  Laity Credential Status
Lay Member                                                                                        Lay Professional
     □ Representing a church or charge                                                                  □ Diaconal Minister Active/Retired
     □ At-large from a district                                                                         □ Deaconess
     □ At-large from Annual Conference                                                                  □ Lay Missioner/Minister
     □ At-large Youth
                                                                 Clergy Credential Status
Elder                  Deacon                 Local Pastor                       Provisional                        Associate              Other

□Effective □Active      □Full-Time                                               □Active                            □Active     □Elder, Other Conf.
□Retired    □Retired    □Part-Time                                               □School                            □Retired    □Deac., Other Conf.
□Incapacity □Incapacity □Student                                                 □Incapacity                        □Incapacity □Stdnt, Other Conf.
□Leave      □Leave      □Retired                                                 □Leave                             □Leave      □Other Denom.


                                         Please be sure to fill out information on the next two pages!
  Friday evening reception included in the cost of registration. Prices include all food, beverage, taxes and
                                                 service fees.

                                                                     Dietary Requirements
                                                                  _________________ Vegetarian

                                                                                                        # of Tickets                                   Total

Friday Night Spiritual Meal Event       6:30 p.m.
(Included in registration, only mark for extra meal)                                                    _______ @ $30 each                             __________

Saturday Breakfast
Mozambique Initiative Breakfast (University Plaza)                                                      ________@ $13.50each                            __________

Saturday Lunch
Saint Paul School of Theology alumni, friends and                                                       ________@ $10 each                              __________
prospective students (Off-site, Pathways UMC)

Sunday Lunch
Fellowship of Local Pastors and Associate Members
(Off-site at St. Paul’s United Methodist Church)                                                         _________@ $10 each                           __________

Cardinal Baseball Tickets
Sunday evening                                                                                            ________@ $8 each                             __________

Total for all items ordered on this page (carry over to last page)                                                        _______________

                                                  Annual Conference Registration Fees
                                                          (Includes Friday evening reception)

                                              Regular Pricing &                                                                            Retiree Pricing &
                                              District At-Large                                                                            Conference At-Large
Early Bird Discounted Rate (Register by May 1)      = $130                                                                                       = $0
May 1 – May 24                                      = $155                                                                                       = $40
Late Fee – May 25 or later                          = $180                                                                                       = $65

                                                                                 Registration Fee $___________


The journal is not included in registration fee. You will not receive a journal next year if you do
not order here:

____________Traditional Printed Version @ $35 each =                                                                ______________

____________Electronic Version @ $6.50 each =                                                                       ______________

Meals and Items from Page 2 =                                                                                       ______________

TOTAL AMOUNT ENCLOSED:                                                                                              ______________


                                                                Registration Information
We encourage you to register online if possible; if you register online you do not need to mail in a
registration form. Go to www.moumethodist.org/ac12 to register.

Send Check Payments and Mail- in Registration to:
          Missouri Annual Conference
          3601 Amron Ct.
          Columbia, MO 65202
          Attn: Mike Harrison

Make your check payable to: Missouri Annual Conference
(Do not combine with other conference remittances please)

Hotel reservations are not made with our office, please see Hotel Reservation Form or go to

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