MDLA 2022 Mid-Winter Conference Refund Request Form

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Please Note:
First Name *
Last Name *
Company *
Email Address *
I would like to: *	Keep my registration for the April Conference Receive a full refund
If you registered by check or in case we are unable to process your refund on the credit card that was used for payment, please fill out the following information below.
Full Name (check made payable to)
Address Line 1
Address Line 2
City
State
Zip/Postal Code
Additional Information
Due to the high volume of refund requests, please allow our staff 2 weeks to process your refund. Please note that your refund will not begin processing until you have filled out and submitted this form.

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