MPI CRV 2017 Spring CMP Study Group

Please register for our 2017 Spring CMP Study Group by completing the form below. If you have any questions, contact Allyson J. Deckman at (860) 541-6438 or mpicrv@gmail.com.

(* Denotes Required Fields)

Personal Information

First Name: *
Last Name: *
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Job Title: *
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Membership: *
Primary Chapter: *
Pursuant to the American with Disabilites Act, do you require specific aid or services?
Special Needs:
Do you know of anyone that would be interested in learning more about MPI CRV?

Guest Information

Photo Release Statement

I give the MPI Connecticut River Valley Chapter, the absolute right and permission to use my photograph(s) in its promotional materials and publicity efforts. I understand that the photograph(s) may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet, World Wide Web), or other form of promotion for the Chapter. I release MPI CRV, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use.
I have read and agree with the Photo Release Statement. *  

Donations

Would you like to make a donation to the MPI Foundation? If so, please enter the amount here: Amount: $

Payment Information

Please choose the number of registrations for each pricing category:
Member Quantity: Cost: $75.00
Non-Member Quantity: Cost: $150.00
Payment Method: *  
  • Send check or money order to:
    MPI CRV, Attn: Allyson J. Deckman
    701 Hebron Ave - Third Floor, Glastonbury, CT 06033
  • Confirmation of your registration will be sent via email.

Payment and Cancellation Policy

  • Check or money order must be received by 1/24 or you will be contacted to guarantee with a credit card.
  • All cancellations must occur by 5:00 pm on 1/24 for full refund; no refunds after 1/24
  • Anyone who does not show for the event will be charged.
I have read and agree with the above Payment and Cancellation Policy. *  

Credit Card Payment Information

(All credit card information must be filled out completely to make a payment.)
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Confirmation Email

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MPI CONNECTICUT RIVER VALLEY CHAPTER

701 Hebron Avenue - 3rd Floor
Glastonbury, CT 06033
Phone: 860.541.6438

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