VATE 2010 VATE Conference Registration

Title:	Dr Mr Mrs Ms
First Name:
Last Name:
Institutional Affiliation:
Position and/or Title:
E-mai (required)l:
Street Address :
City, State, Zip:
Home Phone:
Work or Cell Phone:
VATE Affiliate or School District:
Please check all that apply :	VATE Member VATE Board Member VATE Affiliate Member Author/Speaker V-NAME Member VATE Affiliate Leader Conference Presenter First time Conference Attendee
OPTIONAL-Ethnicity:	African American Native American Asian American European American Hispanic/Latino American Pacific Islander Other
FREE: Friday, October 22 Opening Social with the Poetry Society of Virginia	Are you attending? Yes No
FREE: Saturday Morning, October 23 Continental Breakfast	Are you attending? Yes No
FREE: Saturday Morning, October 23 General Session kick-off with Dr. Bill Bosher	Are you attending? Yes No
FREE: Saturday Afternoon, October 23 Refreshments with Publishers and Vendors	Are you attending? Yes No
If you would prefer to fill this out and mail it, download PDF registration form . If you have questions or additional comments, contact Chuck Miller.

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