REGISTRATION FORM

EVENT:    BVA MID-ATLANTIC REGIONAL GROUP SPRING MEETING

WHEN: MAY 21, 2016

WHERE:    FOUR POINTS SHERATON HOTEL

                    4700 SOUTH LABURNUM AVE.

                     RICHMOND, VIRGINIA 23231

 

NAME:______________________________________________________________________

ADDRESS:___________________________________________________________________                        

CITY:  _____________________________   STATE: _________________  

ZIP: __________

 TELEPHONE: ____CELL ____HOME (         ) _____________________  

EMAIL:_________________________________________

___        I PLAN TO ATTEND THE REGIONAL GROUP'S PRING MEETING.

___    NUMBER OF GUESTS THAT WILL ATTEND WITH ME  

___        I CANNOT ATTEND, BUT I WOULD LIKE TO SUPPORT THE EVENT WITH MY ENCLOSED CONTRIBUTION.

 

___        I DESIRE THE AGENDA IN BRAILLE.

A $15 PER PERSON REGISTRATION FEE IS REQUIRED TO COVER THE COST OF THE MEETING AND LUNCH. PLEASE MAIL THIS FORM WITH YOUR REGISTRATION FEE BY APRIL 16, 2016 TO:

DORIS JONES 

P.O. BOX 2251

MECHANICSVILLE, VIRGINIA  23116