PSATS WORKSHOP REGISTRATION FORM (print and copy this form as needed; each person
may register for only one seminar per form)
Click
Hereto download this form in PDF Format
(Download
the Free Acrobat Reader )
Nickname or Badge Name
Name
Title
Municipality &
County
Address
City, State, Zip Code
Daytime Phone
Fax
Email
Accessibility/Other
Needs
Workshop Name
Workshop Date/Location
Registration Fee
Is Registrant A Qualified
Tax Collector?
__ Yes __ No
Is Registrant An Elected
Official?
__ Yes __ No
_____ Yes,
I would like to receive IIMC credit for attending the __________________________ course. (Please add $10 to your registration fee. For information on the IIMC program visit www.iimc.com or call 717-477-1430.)
Print this form and
return the
form and check (made payable
to 'PSATS') to:
Pennsylvania State Association of Township Supervisors
4855 Woodland Drive
Enola, PA 17025
or fax it to: (717) 763-9732
