2017 Workshop Registration (Required)

Workshops are free - seats may be limited based on number of registrants and capacity.
Everyone registering MUST attend the 1:00 - 3:30 p.m. session.
The 10:30 a.m. session is optional, meant for those local governments who are new and have not completed the required participation forms or those who have been recently assigned the duties of debt setoff. However, those currently participating are still welcome. There is always plenty of room for this session.
please register your vendor/third-party administrators that will be attending.
For more than 5 attendees, please complete a separate registration form.
For changes or cancellations once submitted, send an email to ncsetoff@ncsetoff.org, no need to re-do entire registration form.
NOTE: LUNCH IS ON YOUR OWN!

Required Information - #1 - 8

1. Local Government Name
2a. Type	City/Town County or County Department Water & Sewer Auth. (Ch. 162A Art. 1) Joint Regional Agency (Ch. 160A Art. 20) Public Health Authority (Ch. 130A Art. 2) Metro. Sewerage Dist. (Ch. 162A Art. 5) Sanitary District (Ch. 130A Art. 2) Housing Authority (Ch. 157) Regional Solid Waste Management Authority (Ch. 153A Art. 22) Vendor/Third-party administrator Other
2a. If Other, please specify
3. What is the status of your Local Government with the Debt Setoff Clearinghouse?	Active (currently submitting debts) Inactive (submitted forms but not debts) New (no forms or debts submitted)
4. Have you ever attended a Debt Setoff Clearinghouse Workshop?	Yes No
5. Location	a) Wilmington - Tue., Oct. 3, 2017 - New Hanover County Government Center, 230 Government Dr 28403 b) Washington - Wed., Oct. 4, 2017 - Beaufort County Community College, Bldg. 8 Auditorium, 5337 Hwy 264 East 27889 c) Raleigh - Thu., Oct. 5, 2017 - Local Govt. Federal Credit Union Corporate Office, 3600 Wake Forest Rd, Raleigh 27609 d) Asheboro - Tue., Oct. 10, 2017 - Public Works Facility, Conference Rm.1312 North Fayetteville St 27204 e) Hickory - Wed., Oct. 11, 2017 - City Hall Council Chambers,76 North Center St 28601 f) Waynesville - Thur., Oct. 12, 2017 - Police/Planning Zoning Building, 9 South Main St 28786
6a. Session	a) 10:30 - 11:30 a.m. (OPTIONAL - focus is on new participants not yet submitting debts) b) 1:00 - 3:30 p.m. (MANDATORY - everyone attending needs this session) d) Both sessions
6b. 10:30 - 11:30 a.m. Optional Session Reason	Never been before Attended before - need a refresher course Debt Setoff is/will be a new responsibility
7) Are there any topics or issues you would like covered at the afternoon workshop for all attendees?

8a. Name
8b. Email Address
8c. Department
8d. Job Title or Description
8e. Phone Number
9a. Name of Attendee #2
9b. Email Address of Attendee #2
9c. Department of Attendee #2
9d. Job Title or Description of Attendee #2
10a. Name of Attendee #3
10b. Email Address of Attendee #3
10c. Department of Attendee #3
10d. Job Title or Description of Attendee #3
11a. Name of Attendee #4
11b. Email of Attendee #4
11c. Department of Attendee #4
11d. Job Title or Description of Attendee #4
12a. Name of Attendee #5
12b. Email of Attendee #5
12c. Department of Attendee #5
12d. Job Title or Description of Attendee #5

2017 Workshop Registration (Required)

Workshops are free - seats may be limited based on number of registrants and capacity.

Everyone registering MUST attend the 1:00 - 3:30 p.m. session.

please register your vendor/third-party administrators that will be attending.

For more than 5 attendees, please complete a separate registration form.

For changes or cancellations once submitted, send an email to ncsetoff@ncsetoff.org, no need to re-do entire registration form.

NOTE: LUNCH IS ON YOUR OWN!