Citizen Planner Jackson County Classroom Program

Register Individuals Here

Required fields are indicated with an asterisk (*)

* First Name

* Last Name

Title

Organization/Unit of Government

* Address

Addt'l Address

* City

* State

* Zipcode

* Day Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

* I would like to attend the Citizen Planner Jackson County Program ($250.00)

Special Dietary Needs: If you indicate an allergy, please specify if it's ingested or airborne. Please provide as much information as possible about your restrictions so that we can appropriately meet your needs.

How did you learn about Citizen Planner?

* I learned about the MSU Extension Citizen Planner program from

If other source, please identify:

Photo/Audio/Video Release

I authorize Michigan State University to record my image and voice and give Michigan State University and all persons or entities acting pursuant to MSU's permission or authority, all rights to use these recorded images. I understand that said images will be used for educational, advertising and promotional purposes in all conventional and electronic media, and any future media. I also authorize the use of any printed material in connection therewith. I understand and agree that these images and recordings may be duplicated, distributed with or without charge, and/or altered in any form or manner without future/further compensation or liability, in perpetuity.

* Please Indicate your authorization

Contact Information

For more information, contact Citizen Planner at cplanner@msu.edu