First Name:*

Last Name:*

School Building:*

School District:*

Billing Address:*

City:*

State:*

Zipcode:*

Phone Number:

E-mail Address for Confirmation:*

SMCAA Member Status: Member    Non-Member

Total Cost: $

P.O. Number:*
(all registrations must be submitted with a pre-approved purchase order number to be accepted.)

By submitting this registration form you hereby agree to give permission to SMCAA, granting full right of ownership and free use without restriction of photographs of yourself, for any and all purposes in promoting education in Missouri, including but not limited to printed publications, websites, and electronic newsletters.