Registration Form

MAY 24-26, 2022 • TREASURE ISLAND RESORT & CASINO

REGISTRATION

Please fill out the form below OR ONLINE at www.mnfuneral.org/event/convention2022

REGISTER EARLY AND RECEIVE A $25 DISCOUNT! Complete the registration form below and return it to MFDA postmarked on or before Friday, May 13, 2022 and save! Forms returned after May 14 should include the full registration fee.

We’re proud to offer Minnesota CEUs in all categories required by the State of Minnesota.

NFDA’s Certified Crematory Operator Program Training will be held at Convention this year on Tuesday, May 24 – register at www.nfda.org.

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Name (please print/type): Name on badge:

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Firm name:

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Address (city, state, zip):

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Cell Phone: ( ) Email:

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Registration* Please select the appropriate registration fees below. Subtotals ❑ MFDA Member Funeral Director: $200 ($225 after May 13)

$ ______________ ❑ MFDA Funeral Home Preneed Counselor: $200 ($225 after May 13) $ ______________ ❑ Guest**: $100 ($125 after May 13) Guest name for badge:______________________________________ $ ______________ ❑ U of M Mortuary Science Student/Intern/2022 Graduate: Free ($30 after May 13)

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❑ Non-Member: $670 ($695 after May 13) $ ______________

❑ Past Presidents Breakfast (for MFDA past presidents only): $25

$ ______________ ❑ Wednesday Party Your Heart Out Guest***: $50 Guest name for badge: _______________________ $ ______________

Indicate if you’ll attend the Networking Event, as well as the number of free registered attendees with your group. ❑ Wednesday Party Your Heart Out

Free registered Convention attendees # attending _____

Total Enclosed $_____________

❑ MASTERCARD ❑ VISA ❑ AMEX ❑ DISCOVER ❑ Check (Payable to MFDA)

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Credit card #: Exp: / CSV code: Billing zip: _________________________________________________________________________________________________________________ Name as it appears on card: Signature:

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❑ Check here if you require special assistance or have dietary requirements, and attach a statement of your needs.

*Registration includes daily admission to Convention program sessions/CEUs, all Exhibit Hall functions, all meals and Wednesday evening’s event. Non-Minnesota Funeral Directors who are members of their state Funeral Director Association (ND, SD, WI, and IA) can register as an MFDA Member Funeral Director. ** A Guest is a non-funeral director who is a guest of a licensed funeral director. Out of respect for our exhibitors, non-exhibiting suppliers or allied members are not allowed to register or attend the Convention. *** Wednesday Party Your Heart Out! Guest Ticket will only be allowed to attend the Party Your Heart Out! event. A wristband will be provided at MFDA’s registration desk - please pick up your wristband by 6:00pm on Wednesday. You may purchase a Wednesday Event Guest ticket for more than one person. A portion of your ticket purchase will go towards Healing Hearts of Hope to provide grief camps for families.

SEND COMPLETED FORM: By Fax (with credit card information) to: 763-335-9844 By Mail (with payment) to:

Minnesota Funeral Directors Association 7046 E. Fish Lake Rd

Maple Grove, MN 55311