U.S. Food and Drug Administration
Missouri Department of Health
Kansas City Department of Health
Missouri Milk, Food and Environmental Health Association
REGISTRATION FORM
Name:___________________________________
Agency:__________________________________
Mailing Address:____________________________
City:____________________________________
State:___________________________________
Zip Code:_________________________________
Phone:___________________________________
Fax:_____________________________________
E-Mail:___________________________________
Course Cost:
$20.00 if pre-registering, $25.00
if registering at the door. (includes coffee and breaks). Make check payable to:
Missouri Milk Food & Environmental Health Association (MMFEHA).
Pre-registrations are preferred.
(January 3, 2001 is cutoff date for pre-registration)
Attn: Gala Jaramillo
Missouri Milk, Food and Environmental Health Association.
P.O. Box 105017
Jefferson City, MO 65110-5017
Phone # is (573) 634-6418
Seats are limited, please submit registration form as soon as possible. Course space
will be filled in order of receipt of registration. Those accepted into the course will
receive written confirmation. Registration will close after the course is filled.