2017 Fall Certification Program for Municipal Clerks, Tax Collectors, and Deputies

Registration Form

2017 Fall Session (III-N) of the Certified

Municipal Clerks, Tax Collectors, and Deputies (CMC) Program

First Name *

Last Name *

Title *

Municipality *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Updates

Pearl (September 20-22)

Oxford (Oct 11-13)

Hattiesburg (Oct 18-20)

Registration Fee: $200.00

To help us prepare for this session of the certification program, please check any of the following that apply to you: *

This is the first session of the certification program I have ever attended.

I am attending this session to work toward certification.

I am attending all or part of this session on an interest basis only.

I am already a graduate of the certification program.

Note: I understand that if I register for the course but do not attend, the registration fee is still due and payable since materials have been printed, classroom space has been reserved, and the cost of lunch on Thursday and refreshments for both days have been guaranteed based upon my registration. A course registration may be cancelled without penalty if cancellation takes place on or before the Friday prior to the day the class is scheduled to start.

Mail Payment to:

Center for Government and Community Development

Box 9643 Mississippi State, MS 39762