Fall Foliage Conference Thursday-Friday October 26-27, 2017
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First Name: *
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Phone Number (+ area code): *
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Email Address: *
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Registration: *
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Housing (NCECBVI Dorm): *
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School District/ESU Name: *
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School District/ESU Street and/or P.O. Box (for billing): *
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School District/ESU City: *
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School District/ESU Zip: *
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Name of Person to Contact About Billing (if questions): *
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Billing Person's Phone Number (+area code): *
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Billing Person's Email Address: *
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Payment(check should be received by October 7, payable to NCECBVI): *
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How did you hear about this conference?: *
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Please Note Any Accommodations Needed: *
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Name of Emergency Contact: *
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Relationship to Emergency Contact: *
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Phone Number (s) for Emergency Contact *
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