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Name
Gender
Mailing Address
T-Shirt Size*
Focus Area
Are You Presenting?
Do you have special dietary needs?

Please Mail $160 per person Payment to:

Northeast Mississippi Community College
c/o Mobile Learning
101 Cunningham Blvd
Booneville, MS 38829

Please call the Business Office at 662-720-7281 and tell them that you would like to pay for Mobile Learning.

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