2022 Workshop: MAY 4-6, 2022 Register Below. For more information, please visit the Workshop section of the website. 2022 Registration Registration is closed except to SCHOLARSHIP PARTICIPANTS. However, you may register if you would like to be on the waiting list. You will not be charged for registration now, but we'll keep your contact information and be back in touch in early April if we have any cancellations. Prefix Ms. Mrs. Mr. Dr. Judge Mayor Race (for statistical purposes) American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian White Prefer not to answer Age Range (for statistical purposes) 15-24 25-34 35-44 45-54 55-64 65 and over Prefer not to answer Name First Last Last Gender (Used for room assignments.) Male Female Email Organization Professional Title/Occupation Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal County Work Phone Cell Phone Phone Number in case of emergency Dietary Restrictions or Special Needs Required (we will attempt to accommodate requests) Name you desire on your NAME TAG Room Choice Scholarship (Double Occupancy) You must note who is providing scholarship below. Double Occupancy $325 (You will be Assigned a roommate!) Single Occupancy $375 (NOTE: Single rooms are limited and filled on a first-come/first served basis) Spouse/guest meals ($60) Yes ($60) Scholarship Provided by Roommate (if known) otherwise, we'll assign a roommate to you. If you have a scholarship, please choose the "I'll mail in a check" option below. How Would You Like to Pay? By Credit Card (see below) I'll Mail in a Check Total to be charged Please mail your check made out to Your Town Alabama to the following address:Your Town Alabama 2112 11th Ave S, Suite 541 Birmingham, AL 35205 Credit Card Credit Card Credit Card Credit Card Month 1 2 3 4 5 6 7 8 9 10 11 12 Credit Card Year 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Credit Card All refund requests will be subject to a $150 fee; the remainder of the fee will be refunded if cancelled 30 days prior to the workshop. No refunds will be issued within 30 days of the workshop. Registrations may be transferred to another person at no cost if a completed application is received 30 days prior to the workshop. Please email us at info@yourtownalabama.org with any questions, cancellations, and transfer requests. Optional Message If you are human, leave this field blank. Pay Now
