MSU Extension Zoning Administrator Certificate Program

Register

Required fields are indicated with an asterisk (*)

Registrant Information

* First Name

* Last Name

* Unit of Government/Organization

* Address

Addt'l Address

* City

* County

* Zipcode

* 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.

Certify Eligibility

Eligibility for the ZAC Program requires that participants have completed the MSU Extension Citizen Planner Program or have the American Institute of Certified Planners (AICP) credential before starting the program.

I certify that I...: * Have completed the MSU Extension Citizen Planner Program. Have the AICP credential (please upload documentation below). Am currently enrolled in Citizen Planner program (online or classroom).

Please upload a screenshot or scan of your 'My APA' page to document AICP status: Login to the APA website at www.planning.org and click 'My APA' at the top right.

Food Preferences

Special Dietary Needs: Lunch, snack and dinner for February 20, and breakfast, snack and lunch for February 21 are included with registration. Please list food allergies and/or dietary preferences to make sure accommodations are made.

Registration

* I would like to register for this event ($575.00)

Photo/Audio/Video Release I authorize Michigan State University to record my image and voice (or that of my minor child named here) 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, please contact Kara Kelly, ZAC Program Coordinator, at cplanner@msu.edu.