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Online Registration NO
longer available!
To register please
contact the Virginia Department of Education:
Caroline Fuller
caroline.fuller@doe.virginia.gov
(804)-225-2431 or
Mary Hall
mary.hall@doe.virginia.gov
(804) 786-5703
I. General Information
Clearly type all
information EXACTLY as you wish it to appear on your meeting badge.
First
Name: MI:
Last
Name:
Degree:
Organization/School (As you would like it listed on your name
badge.):
Address
Street:
City:
State:
Zip:
Daytime Telephone
This address is:
Home
Business
E-mail Address:
Confirm Email:
Check this box if you do not want this information included in the
Attendee Directory.
Do you require special accommodations
to fully participate in the meeting?
No
Yes
(If yes, please list details of your
special needs.)
II. Employment Status
Select the option that best characterizes your position:
School Nurse
Family Life
Educator School
Health Educator
Division
FLE Supervisor
Community
Health Educator
Other
(please explain):
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