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2022 Region IV IIMC Conference
When completing your information please use the correct sentence case. (Do not type in all caps)
First Name:
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Last Name:
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Municipality Name Only (Ex. Starkville)
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Title:
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Telephone Number:
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Email Address:
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State
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Arkansas
Louisiana
Mississippi
Oklahoma
Texas
Ohio
Are you a new clerk with less than 1 year of experience?
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Yes
No
Will you be booking a room at the Sheraton?
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Yes
No
Registration Options
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Athenian Dialogue $50
(2 remaining)
Region IV Conference $215
(52 remaining)
Business Meeting Only
Please indicate any special accommodations you might require?
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I understand that if I register for the conference but do not attend, the registration fee is still due and payable if not canceled before the registration deadline.
Gender (For Reporting Purposes Only)
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Male
Female
Other/Unidentified
Ethnicity (For Reporting Purposes Only)
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Hispanic or Latino
Not Hispanic or Latino
Unidentified
Race (For Reporting Purposes Only)
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other/Unidentified