2023 Virtual Workshop Registration (Required)


Required Information - #1 - 5
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
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
5. Session Counties, Agencies, Municipalities, and Housing Authorities: Wednesday, November 1 (9:30 - 11:30 a.m.)
6a. Name
6b. Email Address
6c. Department
6d. Job Title or Description
6e. Phone Number
7a. Name of Attendee #2
7b. Email Address of Attendee #2
7c. Department of Attendee #2
7d. Job Title or Description of Attendee #2
8a. Name of Attendee #3
8b. Email Address of Attendee #3
8c. Department of Attendee #3
8d. Job Title or Description of Attendee #3
9a. Name of Attendee #4
9b. Email of Attendee #4
9c. Department of Attendee #4
9d. Job Title or Description of Attendee #4
10a. Name of Attendee #5
10b. Email of Attendee #5
10c. Department of Attendee #5
10d. Job Title or Description of Attendee #5