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Mail To:

Registration Services
The University of Alabama
Box 870398
Tuscaloosa, AL 35487

Which event are you attending?

[  ] In-person:  Municipal Clerks Winter Conference CS-2211-MCAC01-01: November 30-December 2, 2022, Registration: $285 (Early Bird of $265 until 10/31/2022)
[  ] Live-stream: Municipal Clerks Winter Conference CS-2211-MCAC01-02: November 30-December 2, 2022, Registration: $285 (Early Bird of $265 until 10/31/2022)
[  ] In-person:  Spring Municipal Clerks Training Institute CS-2305-MCSI01-01:  May 3 – 5, 2023, Bryant Conference Center, Registration: $285 (Early Bird of $265 until 4/15/2023)
[  ] Live-Stream: Spring Municipal Clerks Training Institute CS-2305-MCSI01-02:  May 3 – 5, 2023, Bryant Conference Center, Registration: $285 (Early Bird of $265 until 4/15/2023)
[  ] In-Person: Fall Municipal Clerks Training Institute CS-2210-MCFI01-01:  October19-21, 2022, Bryant Conference Center, Registration: $285 (Early Bird of $265 until 8/31/2022)
[  ] Live-Stream: Fall Municipal Clerks Training Institute CS-2210-MCFI01-02:  October 19-21, 2022, Bryant Conference Center, Registration: $285 (Early Bird of $265 until 8/31/2022)

Which credential do you need?

[  ] Seeking CMC
[  ] Seeking MMC
[  ] Maintenance Hours

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:________Last:____________________________

Preferred Name/Nickname:____________________________

Company/Organization Name:____________________________

Mailing Address:____________________________City:____________________________State:________Zip:______________

Email Address:____________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code____________________________(Three or four digit code on back or front of credit card.)

Authorizing Signature:____________________________