WCUCOM SOMA Crawfish Boil

April 14, 2018; 11:00 am - 3:00 pm
Neal House, 1315 Hardy St., Hattiesburg, MS 39401

Complete the form below to register for the 2018 WCUCOM Student Osteopathic Medical Association Crawfish Boil.

All fields in red are required to submit this form.

Personal Information


Contact Information










Company Information


Order Information

Enter the number of tickets you would like for each of the following:




Donation Information

You may be designated as a prestigious donor at the following levels:

  • $100 - Display on banner and signs, Receives a crawfish pin, Up to 5 lbs of free crawfish
  • $250 - Prominent display on our banner and signs, Recognized as a Silver Sponsor on certificate, Receive crawfish pin(s), Up to 10 lbs of free crawfish
  • $500 - Prominent display on our banner and signs, Recognized as a Gold Sponsor on certificate, Receive crawfish pin(s), Up to 25 lbs of free crawfish.

I would like to donate $ to the WCUCOM SOMA.

Payment Options

Please select the method you would like to use to make your payment:




WCUCOM SOMA, Box 207 | c/o Emily Bennett | 710 William Carey Parkway | Hattiesburg, MS 39401