First Name:
Last Name:
Title:
Company:
Street:
City, State, Zip:    

Phone:    - 
Fax:    - 

Email:

 Member and/or Guest Registration $250.00
(INCLUDES DUES FOR 2017, CONFERENCE, LUNCH, RECEPTION AND NETWORKING BUFFET).
 Non-Member Registration $275.00
(INCLUDES DUES FOR 2017, CONFERENCE, LUNCH, RECEPTION AND NETWORKING BUFFET).
  My spouse will attend.  ($25)
  My spouse will NOT attend.
  (Spouse's Name)

Golf Registration $135.00
Name: Handicap:
If paying for more than one golfer, please complete below:
Golf Registration 2nd Player $135.00
Name: Handicap:
Golf Registration 3rd Player $135.00
Name: Handicap:
Golf Registration 4th Player $135.00
Name: Handicap:

Luncheon Only $35.00 Quantity:
Reception Only $55.00 Quantity:
Please indicate how many intend to join us for the Networking Dinner Buffet Quantity:

Donation to support MARS programs and scholarship fund - appreciated and recognized

 
I would like more information about the MARS Young Professionals Committee.


I wish to pay now using my Credit Card.
I am registering now. I will mail the original form with check payable to Midwest Association of Rail Shippers to P.O. Box 357, Wayne, IL 60184-0357 or fax to 866-746-0071.
Type of Credit Card
Name on Credit Card
First: Last:
Card Number: (no dashes)
Exp date:

No refunds after June 9, 2017.