2021 SEDI Registration

First Name *

Last Name *

Position Title *

Agency/Organization Name *

Years in Current Position *

Years with Organization *

Brief Description of Your Current Role *

Oganization Address

Please include street address, city, state, and zip

Brief Description of Your Organization *

Phone Number *

Email *

Individual Address *

Please include Street Address, city, state, and zip

Date of Birth *

Gender

For shirt orders, we make every attempt to order specific for male/female fit from the vendor.

Why is attending this program important to you? *

In your opinion, what is state government's most pressing issue? *

Please describe the biggest issue facing the State and why.

Continual Education Credit? (Approval Required)