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Organization/Company/Group Name

Contact Name

First Name *

Last Name *

Title

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Address 1

Address 2

City

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Zip Code *
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Day Phone *
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Evening Phone
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Fax
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Email *

Session 1: Please Select Either A or B
A    B

Session 2: Please Select Either A or B
A    B

Payment options:
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Please remit payments to:

Vandeventer Black LLP
Attn: Labor & Employment
101 West Main Street, Suite 500
Norfolk, VA 23510

Do you have special dietary needs:

Comments

First Name

Last Name

Title

 Male    Female

Session 1: Please Select Either A or B
A    B

Session 2: Please Select Either A or B
A    B

First Name

Last Name

Title

 Male    Female

Session 1: Please Select Either A or B
A    B

Session 2: Please Select Either A or B
A    B

First Name

Last Name

Title

 Male    Female

Session 1: Please Select Either A or B
A    B

Session 2: Please Select Either A or B
A    B

Thank you for registering. Please send payment upon submission of this registration form.  If you do not hear from us within 48 hours, please call 757.446.8677 and ask for Donna Richards. We look forward to seeing you on October 17th!