2021 Mid-Year Conference Virtual Registration Deadline is Friday, March 12, 2021 2021 VBCOA Mid Year Virtual Conference Payment*Credit CardBy CheckI want to register as a:*Conference AttendeeName* First Last Registered Attendees's Name* First Last Enter name of the attendee who you will be a companion for. Locality/Company*Additional Delegate(s)Enter total number of additional delegate(s)Number of additional registrations from locality (please enter attendee information below)Please enter a number from 0 to 10.Names of additional people attending ($50 per person extra charge):*First NameLast NameTitleEmail Name of Company*Title*Locality*Mailing Address* Address Line 1 Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Registration FeesConference Attendee RegistrationRegistration Registration PaymentTotal $0.00 Please mail a check in the above amount to the following address: Sandra Harrington, VBCOA PO Box 12164, Richmond, VA 23241 Make the check Payable to VBCOA Same as Mailing Address Billing Address* Address Line 1 Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Coupon Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name GLCodePhoneThis field is for validation purposes and should be left unchanged. email facebook twitter linkedin google+