MS STATE CONFERENCE NAACP
69th Annual State Convention and Policy Institute
November 6-8, 2014♦ Vicksburg Convention Center ♦Vicksburg, MS
Hosted by the Vicksburg City Branch NAACP
ADVANCE REGISTRATION POSTMARK DEADLINE: FRIDAY, OCTOBER 17, 2014
Section I – CONTACT INFORMATION
Unit Name ______Unit Number ______Name ______
Last Name First Name MI
Address ______City/State/Zip______
Telephone No. ( ) ______Fax No. ( ) ______Email ______
Section II – POLICY INSTITUTE PACKAGES
A. Branch Registration Package (1 of each) /B. Adult Package (1 of each)
/C. Youth & College Unit Package (1 of each)
/D. Youth & College Package (1 of each)
Branch Registration Fee♦ Adult RegistrationReligious Affairs Luncheon ♦WIN Luncheon
Youth Celebration Reception ♦ Labor & Industry Luncheon ♦ Freedom Fund Awards Banquet / Adult Registration ♦ Religious Affairs Luncheon
Labor & Industry Luncheon ♦WIN Luncheon ♦ Freedom Fund Awards Banquet / Youth & College Unit Registration♦
Youth Registration♦
Youth Celebration Reception ♦
Saturday Luncheon♦
Adult Freedom Awards Banquet♦
Friday & Saturday Y&C Socials / Youth Registration♦
Youth Celebration Reception♦
Saturday Luncheon♦
Friday Y&C Social♦
Packages
/ Advance (before October 17, 2014) / On-Site (after October 17, 2014) / TotalA. Adult Branch Package
/ $250.00 x ______ / Not Available / $B. Adult Package
/ $150.00 x ______ / Not Available / $C. Y & C Unit Package / $ 65.00 x ______ / Not Available / $
D. Y & C Package / $ 25.00 x ______ / Not Available / $
Total Package Fees / $
Section III –REGISTRATION FEES
Category / TotalBranch/Unit Assessment / (Adult) $100.00 x ______ / (Youth) $50.00 x ______ / $
Advance (before October 17, 2014) / On-Site (after October 17, 2014) / --
Adult Registration / $40.00 x ______ / $45.00 x ______ / $
Y & C Registration
/ $15.00 x ______ / $20.00 x ______ / $Total Registration Fees
/ $Section IV –TICKET ORDERS
Ticket Prices /Total
Religious Affairs Luncheon – Thursday, November 6, 2014
/ $25.00 x _____ / $WIN Luncheon – Friday or Saturday / $25.00 x _____ / $
Labor Luncheon – Friday or Saturday / $25.00 x _____ / $
Youth Friday Night Social– Friday or Saturday / $5.00 x _____ / $
Youth Awards Luncheon – Saturday, November 8, 2014 / $15.00 x _____ / $
Freedom Awards Banquet - Saturday, November 8, 2014 / $50.00 x _____ / $
Total Ticket Sales / $
Section V – SOUVENIR BOOKLET ADS – FOR BRANCHES ONLY
Ad Price
/Total
Full Page Ad (8.5 x 11)
/$100 x ______
/$
Section VI- TOTALS
Section II $ ______+ Section III $ ______+ Section IV $ ______+ Section V $ ______=GRAND TOTAL $ ______
Section VII – PAYMENT METHOD – Indicate Payment Type Below
Check No. ______ Money Order No. ______ Cash ______69TH ANNUAL MS STATE CONFERENCE NAACP & POLICY INSTITUTE
REGISTRATION LISTING
Please Type Or Print Neatly!
Adult Registration(s)
Names(Last, First, MI) / President / Vice President / Secretary / Treasurer / Delegate / Alternate / Observer / Diet Restriction
Youth Registration(s)
Names(Last, First, MI) / President / Vice President / Secretary / Treasurer / Delegate / Alternate / Observer / Diet Restriction
NOTE: Please make copies of all completed forms for your records.
ADVANCE REGISTRATION POSTMARKED DEADLINE: FRIDAY, OCTOBER 17, 2014.
NAACP Mississippi State Conference
1072 W. Lynch Street, Suite 10
Jackson, Mississippi 39203
For more information, email at or by calling (601) 353-8452.*You max fax this form to (601) 353-1565 or email to .*