b'MRCA 73rd Annual Conference & Expo M R C A F O U N D A T I O N p r e s e n t s October 18-20, 2023Contractor Registration FormCHI Health Center - Omaha, NE This registration form is for use by Contractors, Consultants, Specifiers, Code Officials, Engineers, Architects, and Insurance Agents.1 1 t h a n n u a l Company Name______________________________________________ Online registration available at www.mrca.org ________________________________________________ Attendee Badge Name #1 ______________________________ Unique Email (required) _____________________________________ Attendee Badge Name #2 ______________________________ Unique Email (required) _____________________________________ Attendee Badge Name #3 ______________________________ Unique Email (required) _____________________________________ Company Address ______________________________________________________________________________________________ thursday City _______________________________________State _______ Zip ___________Work Phone ___________________________ d r e s s c ode FULL Registrations:Includes Educational Sessions, MRCA Membership Meeting, Keynote Address, MRCA Welcome Reception 19th oct black & white and Foundation Auction, Meals, and Access to Exhibit Hall. (Excludes activities requiring separate registration fees below in Section B) Member Full Registration$350 Additional Member Full Registration*$150x___ attendees = $___________ Non-Member Individual Full Registration$550(Note: Join and Register is better Additional Non-Member Full Registration* $400x___ attendees = $___________ value if registering more than 1 person) black & white * Discount for Additional is available only if registrants are from the same company. Also available to spouses or guests of attendees. Join and Register Option for All Contractors: Become an MRCA Member today and receive Silver Level Membership through 12/31/2024 and 1 complimentary FULL registration! ball Join MRCA and Register $795 Additional New MRCA Member Registration* $150 x___ attendees = $___________1-Day Registrations: Includes 1 day of General Educational Sessions and Access to the Exhibit Hall.(Excludes activities requiring separate registration fees below in Section B.) Check the day you will attend: 1-Day Member Individual Registration$175 Wednesday$175 Thursday 1-Day Non-Member Individual Registration $275 Wednesday$275 Thursday Selected rate $_______x___ attendees = $___________ EXPO ONLY Registrations: Contractors, Consultants, Specifiers, Code Officials,Engineers, Architects, Insurance Agents: FREE Non-Exhibiting MFRS, SUPPLIERS and REPS:$675 per person S UBTOTAL B OXA:$ _______________Activities Requiring Separate Registration Fee:Special Notes/Requests: r e c e p t i o n & a u c t i o n All registrations below can be stand-alone registrations This is my First MRCA Conference & ExpoHAWT Instructor Training Course for Trainers (Includes Meals & Access to Exhibit Hall) I am 40 or under and interested in the Young Contractors Council$550 per person for MRCA MembersI require special assistance onsite. Please contact me. sponsored by$650 per person for Non-Members I have a dietary preference for meals. Please specify:HAWT Applicator Training Course for Applicators (Includes Meals & Access to Exhibit Hall) _____________________________________________$300 per person for MRCA Members$400 per person for Non-Members Total Payment Due: B OXA + B OXB $ ________________CERTA Train-the-Trainer Course for NEW Trainers and Reauthorization (Includes Meals & Access to Exhibit Hall) $525 per person for MRCA and NRCA Members Check to MRCAVisaMCAmExDiscover$650 per person for Non-Members CERTA Applicator Training Course for NEW Applicators and ReauthorizationCard # ___________________________________________________ (Includes Meals & Access to Exhibit Hall)free to all registered attendees & exhibitors$425 per person for MRCA and NRCA Members$550 per person for Non-MembersExp. Date _______Billing Zip Code _____________ CSV #_______ Y SILENT AUCTION 5PM-8PM Y LIVE AUCTION 6:45PM Young Contractors Council (YCC) Fundraiser Welcome PartyName on Card_____________________________________________ hilton omaha grand central ballroom Yellowstone Theme Casino Night benefitting the Heartland Equine Therapeutic RidingAcademy & MRCA Foundation: Wednesday, Oct. 18th 8-10:30pm at Hilton Omaha$50 per person(this registration fee goes directly to causes noted above)Cancellation Policy: All cancellations must be received in writing. A $15 processing fee applies to all cancellations. No refunds will be given after To Benefit the Educational Programs, Industry Research, andS UBTOTALB OXB: $ _____________ 10/01/2023. All refunds will be processed after the conference. Academic Scholarships for MRCA Members and their FamiliesMail completed form to: MRCA 7250 Poe Ave. Suite 410 Dayton, OH 45414 or Fax to 937-278-0317 or Email to info@mrca.orgNOTE: THE MRCA FOUNDATION QUALIFIES FOR TAX EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS A NOT-FOR-PROFIT CORPORATION (FID 43-1495286). DONORS ARE ENCOURAGED TO CONSULT THEIR TAX ADVISOR FOR INFORMATION ABOUT THE DEDUCTIBILITY OF DONATIONS. www.mrca.orgMidwest Roofer 1717'