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Student Information

First Name

Last Name

Student Preferred First Name

Current Job Title

Employer Address

Municipality / Organization Name

Years in Municipal Service *

VMCA Membership Status *

Size of Municipality *

Primary Job Responsibilities

What is your primary reason for attending?

How did you hear about this program?

Consent to Data Use

“I agree that my data may be used in aggregate by Virginia Wesleyan University (VWU) and the Virginia Municipal Clerks Association (VMCA) for program evaluation, continuous improvement, and reporting purposes. I understand that de-identified data may be used for research, assessment, and publication to support professional education and workforce development initiatives. Participation is voluntary, and individual responses will not be identified in any reports.”

Consent to Future Communications *

Photo/Media Release *

Program Track Selection

Due to a physical disability, is there a need for assistance during your visit to Virginia Wesleyan? If so, please be specific and we will do our best to accommodate?

Student Information

Contact Information