Goochland/Powhatan Drinking Water Clinic September 2019
Please fill in the blanks below and complete your registration by either mailing in a check for $60.00 or by stopping by the Goochland or Powhatan Extension Offices at:

Goochland Extension Office OR Powhatan Extension Office
2748 Dogtown Road 3910 Old Buckingham Road
Goochland, VA 23063 Powhatan, VA 23139


Note: Please refer to the Goochland or Powhatan flyer for specific information on the kickoff meeting in the respective counties. Samples kits are $60.00 each for those who want to test more than one well or multiple tests of the same well before and after a filtration system. Please make your check payable to the "Treasurer of Virginia Tech" *There is a $50 returned check fee*
First Name *
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Last Name *
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Phone *
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E-mail
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Street Address (Street, City, State, Zip) *
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County (which you plan to pick up and drop off your sample kit) *
Number of Sample Kits Requested *
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