Citizen Planner Calhoun 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 Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland & Labrador North Carolina North Dakota Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Not Applicable

* 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 Calhoun County Program ($250.00)

Special Dietary Needs:

How did you learn about Citizen Planner?

* I learned about the MSU Extension Citizen Planner program from   Citizen Planner e-newsletter  Mailed postcard  Local news article  Meeting/Co-worker  Citizen Planner website  Other 

If other source, please identify:

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   Yes  No