Registration - VA ITSN 1-2-3 READ! Training - Charlottesville - January 20, 2024

Business Information

• * Company:
• * Address 1:
• * 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:
• *

  Are you enrolled in VQB5?

  • YES
  • NO

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Phone:
• *

  Position

  • Teacher/Caregiver
  • Director
  • Other
• *

  Type of Program

  • Center-based
  • Home-based
• * Number of children age birth to 36 months with whom you work:

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Non - VQB5 Partners	$25.00
  VQB5 Partners	No Charge

Associate Information

You may add a maximum of 10

• Registration and payment must be received one week prior to training. A $25 non-refundable registration fee is required to reserve your space. No Refunds-substitutes only.

• You may pay the registration fee with a credit card by clicking Pay with a CREDIT CARD below, or call Bertie B. at (757) 378-3168 with the information. If paying your registration by check, please write the location of your training on the MEMO line, and include a list of registrants. Mail your registration/check to: CDR, P.O. BOX 280, Norge, VA 23127. Payment must arrive one week prior to training date.