Mississippi Automobile Dealers Association 800 Woodlands Pkwy, Ste 100 Ridgeland, Mississippi 39157 Fax 601-956-1877 beth@madaonline.com CREDIT CARD INFORMATION Card Number ___________________________________________________ Exp. Date___________/___________ Security Code ___________________ Billing Zip Code__________________ Name on Card___________________________________________________ To register online go to: www.madaonline.com or return registration form with payment. Registration includes: Entertainment, Business Sessions, Receptions, Dinners June 18-21, 2023 Hilton Sandestin Beach Golf Resort & Spa JUNE 18-21 ALABAMA | MISSISSIPPI | TENNESSEE 2023 RESERVE A ROOM USING THIS QR CODE OR CALL 850-267-9500 REFERENCE GROUP CODE: AMN Golf Lunch and Scramble - Monday, June 19 {Burnt Pine Golf Club} $185 Each Name____________________________________ Handicap ___________ Name____________________________________ Handicap ___________ Name____________________________________ Handicap ___________ Name____________________________________ Handicap ___________ Names for Badges Name____________________________________ (His)__________________________ (Her)_________________________ Name____________________________________ (His)__________________________ (Her)_________________________ Firm Name______________________________________________________Telephone______________________________ Firm Address__________________________________________________________________________________________ Email Address_________________________________________________________________________________________ T-Shirt Sizes (1 T-shirt per registrant): SM - Qty____ MED- Qty____ LG - Qty____ X-LG - Qty____ 2X-LG - Qty____ 3X-LG - Qty____ (Last) (Last) Street or Box City State Zip (First) (First) (First) (First) Dealers, dealership personnel, Associate Members, sponsors.........................__________ @$450 each =__________ Spouses/Guests............................................................................................. __________ @$225 each =__________ Children under 18 attending meal functions ....................................................__________ @$150 each =__________ Names:_______________________________________________________________________________________ Non-member allied industry friends and their spouses/guests .........................__________ @$625 each =__________ Golf .............................................................................................................. __________ @$185 each =__________ TOTAL $__________ Do you have any special needs, such as food allergies, for which you need special accommodations?: _______________________________________________________ 10
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