Registration Form – Mississippi Afterburner

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

Name:___ ________________________________________________________________

Address:__________  _______________________________________________________

                _________________________________________________________________

                _________________________________________________________________

Email:   __________________________________________________________________

Phone:  __________________________________________________________________

AMA #:______ ____________________________________________________________

On site registration is $60.00. Pre-registration is $40.00. Pre-registration forms must be received by April 10. Pre-registration fee will be refunded if you can’t make it to the event if request is made by April 10. Make checks payable to Vernon Montgomery. Please print this page and mail to Vernon at the address below. Download registration form here.

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 Fried Catfish and a Crawfish boil with cobbler and five kinds of homemade ice cream.

Mail to:    Vernon Montgomery

                200 Concord Dr.

                Clinton, MS 39056