2019 State Meeting Registration Form
Complete this form to secure your spot at the Virginia Jaycees Fall State Meeting in Farmville, VA.
Name: *
Your answer
Address: *
Your answer
Phone #: *
Your answer
E-Mail Address: *
Your answer
Chapter: *
Your answer
Attendee Type: (mark all that apply) *
Registration Type: *
Total Fees to Be Submitted: *
Your answer
Instructions for Payment:
If paying by check or money order, please make payable to "The Farmville Jaycees."

If paying by PayPal, please visit our state meeting web page after submitting the form to complete the payment process.
Method of Payment: *
Other State Meeting Information
Please visit our web page for additional details, including how to send your payment and hotel information: http://farmvillejaycees.com/events/state-meeting/
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