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MONTANA HORIZONS
Suite 10 Hamilton Hall
P.O. Box 170525
Bozeman, MT 59717-0525

Tel: (406) 994-1754
Fax: (406) 994-1756

Director:
Dan Clark
daniel.clark@montana.edu
Rural Community Conference - MSU Extension and Horizons - January 15 - 16
Registration Form
TO REGISTER:

Online: Please fill out the form below
By Phone: Call 406‐994‐1754
By mail: Download the registration form here and mail to:

Montana Horizons
Rural Community Conference Registration
PO Box 170525
Bozeman, MT 59717‐0525

Name (First, Last) *required.
Organization
Title
Address *required.
City: State: Zip: *RequiredInvalid format.
Phone: Fax:
Email: *required.Invalid format.
Indicate the Category (s) you represent:

Horizons Community Member
Elected Official
Government
Reservation
Faith-based

 Business
Economic Development
Non-Profit
Other
Registration Fees:

$75 if postmarked by December 31st, 2007
$100 if postmarked after December 31st, 2007 or on‐site
Method of Payment:

Full payment is accepted in U.S. Dollars and must accompany this form unless you register online. If you register online you must mail payment to Montana Horizons at the address above. No Credit Cards will be accepted. Make checks payable to Montana State University.
If you have special dietary needs:
If you request ADA accessible accommodations:
Please indicate which of the following you will attend: (there are no extra costs for meals)
January 15th Lunch (prior to Opening Session)
January 15th Buffet Dinner
January 16th Breakfast Buffet
January 16th Lunch
Promote your community or services at the Rural Community Conference Share Fair/Display.
Yes, I/we would like to reserve a space at the Share Fair.
Please indicate the type of space you require:
½ of an 8’table
6’ – 8’ table
floor space
other
Theme of poster/display:
Horizons Community
Education
Housing
Health & Wellness
Youth
Transportation
 Tourism
Arts, Culture & Humanities
Recreation, Natural Resources, & Beautification
Infrastructure
Civic Engagement
Community Foundations
View Text-only Version Text-only Updated: 11/21/07
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