Mississippi Municipal Clerk Association APPLICATION FOR MS CERTIFIED MUNICIPAL CLERK DESIGNATION

It is recommended that you review the paper application prior to starting the online application process.

First Name *

Last Name *

Municipality *

Title *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Gender (For Reporting Purposes Only) *

Ethnicity (For Reporting Purposes Only) *

Race (For Reporting Purposes Only) *

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