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October Quarterly & Director Fall RoundUp Registration
First Name
(Required)
Last Name
(Required)
Nickname on badge (First name only)
(Required)
Cooperative / Company Name
(Required)
Email
(Required)
Cell Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
In case of emergency, please provide the following:
Emergency Contact Name
Emergency Contact Phone
I am a:
Cooperative / Company employee
Guest of an employee
Please select which events you will attend
GA Committee Meeting (For GA committee members only)
GA Committee Meeting (For GA committee members only)
VMD Board Meeting (For VMD board members only)
VMD Board Meeting (For VMD board members only)
Monday Lunch
Monday Lunch
CFC Workshop
CFC Workshop
Monday Reception & Dinner
Monday Reception & Dinner
Tuesday Box Lunch
Tuesday Box Lunch
Event Fee
(Required)
+ $100.00
2022 October registration
Price:
Please provide any dietary restrictions
Additional Comments
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