PSATS WORKSHOP REGISTRATION FORM
(print and copy this form as needed; each person may register for only one seminar per form)

Click Here to 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

Workshop Policies