Mississippi Assistive Technology Conference Registration

The Mississippi Assistive Technology conference will offer practical application based learning with up to 6.5 MS PT Board approved continuing education credits.

Fields with asterisk are required.

Participant's Full Name *

Participant's Job Title

Are you registering in association with a conference sponsor or exhibitor? If yes, please input the sponsor/exhibitor's name here

Please input information about your professional license(s) for which you are seeking CEUs

Please input phone number including area code *

Email *

Address 1 *

Address 2

City *

State *

Zip *

Please input information about any food allergies or restrictions, including instructions for what to do for accidental exposure. If none, please type "N/A" *

Please input information about any disability accommodation requests. If none, please type "N/A" *

Registration Type *

Please input the college or university that you are enrolled in

$0.00

Qty:

If you have any questions about the conference, please contact Rebecca Mathis at rmathis@tkmartin.msstate.edu