b'November 20-22, 2019CONTRACTORREGISTRATION FORM Overland Park, KS (This registration form is for use by Contractors, Consultants, Specifiers, Code Officials, Engineers, Architects, and Insurance Agents.)An online version of registration is available at www.mrca.org Company Name________________________________________________________________________________________________ Full Name for Name Badge #1 ____________________________________ Unique Email(required)______________________________ Full Name for Name Badge #2 ____________________________________ Unique Email(required)______________________________ Full Name for Name Badge #3 ____________________________________ Unique Email(required)______________________________ Company Address _______________________________________________________________________________________________ City _______________________________________State _______ Zip ___________Work Phone ____________________________ Member FULL Registration:Includes Educational Sessions, MRCA Membership Meeting, Keynote Address, MRCA Welcome Reception and Foundation Auction, Meals, and Access to Exhibit Hall. (Excludes activities requiring separate registration fees below in Section B) Member Full Registration$350 AdditionalMember Full Registration*$125 *Discount is available only if registrants are from the same company. Also available to spouses or guests of the Member attending.Name badges will have same company name.The MRCA Member price is also being extended to (KRCA) Kansas Roofing Contractor Association Members. Non-Member Individual Full Registration $550 Join and Register Option for Contractors Become an MRCA Member today and receive Silver Level Membership for 2019-2020 and 1 complimentary FULL registration. Join MRCA and Register $795 Additional New MRCA Member Registration $1251-Day of Conference Registration: Includes 1 day of General Educational Sessions and Access to the Exhibit Hall Thursday and Friday. The MRCA Member price is also being extended to (KRCA) Kansas Roofing Contractor Association Members.(Excludes activities requiring separate registration fees below in Section B.) Check the day you will attend: 1-Day Member Individual Registration$75 Wednesday $175 Thursday$175 Friday 1-Day Non-Member Individual Registration $175 Wednesday $275 Thursday$275 FridayExhibit Hall Access ONLY Registration: Contractors, Consultants, Specifiers, Code Officials,Engineers, Architects, Insurance Agents: FREE Non-Exhibiting Suppliers: $550 per personSubtotalBox A: $ _______________Activities Requiring Separate Registration Fee:Special Notes/Requests CERTA Train-the-Trainer Course for NEW Trainers and Reauthorization This is my First MRCA Conference & Expo(Includes Meals & Access to Exhibit Hall)I am 40 or under and interested in the Young Contractors Council$375 per person for MRCA, NRCA and KRCA (Kansas) Members I require special assistance onsite. Please contact me.$495 per person for Non-MembersI have a dietary preference for meals. Please specify:CERTA Applicator Course(Includes Meals & Access to Exhibit Hall) _________________________________________________$325 per person for MRCA, NRCA and KRCA (Kansas) Members$475 per person for Non-Members Total Payment Due:BoxA + Box B $ _________________ OSHA 10 Hour Training (ENGLISH) (Includes Meals & Access to Exhibit Hall)Check to MRCAVisaMCAmExpDiscover$195 per person for MRCA, NRCA and KRCA (Kansas) Members$300 per person for Non-Members Card # __________________________________________________ OSHA 10 Hour Training (SPANISH) (Includes Meals & Access to Exhibit Hall) Exp. Date ____________ Billing Zip Code ___________________$195 per person for MRCA, NRCA and KRCA (Kansas) Members$300 per person for Non-Members Name on Card____________________________________________ Women in Roofing (WinR) Sponsored Events OnlyCancellation Policy:All cancellations must be received in writing. Wednesday, November 20th- Includes WinR Luncheon, DISC Assessment & DISC SessionA $15 processing fee applies to all cancellations. No refunds will be$99 per persongiven after November 5, 2019. All refunds will be processed after the Young Contractors Council (YCC) Fundraiser Welcome Party conference. Wednesday, November 20th 7:30 - 11:00 PM at the Sheraton Hotel$40 per person Mail completed form to: MRCA 2077 Embury Park Rd. Dayton,Subtotal Box B: _______________OH 45414; Email form to info@mrca.org; Fax to 937-278-0317www.mrca.orgMidwest Roofer 17'