WVHC/WVEC Fall Conference: October 21 – October 23, 2016, Camp Virgil Tate: Green Voices
1400 Camp Virgil Tate Rd, Charleston, West Virginia 25312

Please sign up in advance for lodging and meals. Registration must be submitted by October 10 in order to have a complete meal count.
If you are a couple or family group, only one registration form is needed.

Name: *
Your answer
Address: *
Your answer
Email: *
Your answer
Phone Number: *
Your answer
Number of people being registered: *
Your answer
Select your lodging: *
Required
Select your nights: *
Required
Indicate if you are staying in Maxwell Lodge and wish to be assigned a roommate if available for a $31.80 per night per room cost reduction. If you are a couple or family group registering together, you may indicate private room. *
Required
If you have selected a roommate for Maxwell Lodge who is registering separately, please give the name:
Your answer
Total Cost of Your Lodging: *
Your answer
Select Your Meals: *
Required
Total Cost of Your Meals: *
Your answer
Donation amount to help with conference expenses and/or to benefit the hosting organizations.
Your answer
Total dollar amount for registration, please add your lodging, meals, and donation. *
Your answer
Method of Payment: *
Required
Please comment on anything else we should know about your registration, or tell us if you have special needs for lodging, meals, or the meeting. You may make adjustments to your form online.
Your answer
What are your goals in attending this conference? What are your primary areas of interest?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service