2022 VAPDC Summer Conference

Registrant Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Phone:
• PDC/RC Affiliation:

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Full Conference Registration (Includes all Conference Sessions, Breaks, Events, Meals)	$375.00

Business Information

• * Company:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:

Badge Information

• * Badge Name: (Preferred first name.)

Dietary Restrictions

• Choose all that apply.

  • Allergic to Nuts
  • Allergic to Shellfish
  • Allergic to Wheat
  • Gluten Free Diet
  • Vegan
  • Vegetarian
  • Other (we will contact you for details)

Registration Details & Cancellation Policy

• Online conference registration will close at 5 pm on Thursday, July 14, 2022. A limited number of onsite registrations can be taken at the Conference registration desk; however participants are encouraged to register in advance to ensure participation. No cancellations will be accepted after July 14, 2022. There will be a $25 fee assessed on cancellations prior to July 14, 2022 and no refunds after July 14, 2022.

• Credit Card transactions will include a 2.5% +.50 Platform Fee.

Guest/Spouse Information

You may add a maximum of 1