Registration Form - Mississippi Afterburner

Please pre-register so we can determine the required amount of food.

Name:____________________________________________________________________

Address:__________________________________________________________________

            __________________________________________________________________

            __________________________________________________________________

Email:   __________________________________________________________________

Phone:  __________________________________________________________________

On site registration is $60.00. Pre-registration is $40.00. Pre-registration forms must be received by April 20. Pre-registration fee will be refunded if you can't make it to the event if request is made by April 20.

Saturday night awards banquet dinner is included in registration fee . Please pre-register so we can determine the required amount of food.

Saturday night dinner is a Pig Roast, Fried Catfish, and a Crawfish boil with cobbler and three kinds of homemade ice cream.

Mail to:    Vernon Montgomery

                200 Concord Dr.

                Clinton, MS 39056