Participant Information

Special Note: Conference updates due to emergencies or cancellations will be posted on the Virginia Department of Education website on the Work-Based Learning page and through work and summer email addresses.

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* 1. First Name

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* 2. First Name on your name tag

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* 3. Last Name

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* 4. Prefix

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* 5. Position Title

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* 6. School Division/Organization/Company Name

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* 7. School Name

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* 8. Work Email

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* 9. Work Phone Number

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* 10. Summer Email

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* 11. Summer Phone Number

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* 12. Special Physical Accommodations (Enter N/A if not applicable)

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* 13. Special Dietary Accommodations (Enter N/A if not applicable)

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* 14. See Tour Description Attachment for Choices:  WBL Tour Choice #1
Due to liability reasons, all conference participants MUST use provided and approved charter bus transportation to and from the tour.

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* 15. See Tour Description Attachment for Choices:  WBL Tour Choice #2
Due to liability reasons, all conference participants MUST use provided and approved charter bus transportation to and from the tour.

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* 16. See Tour Description Attachment for Choices:  WBL Tour Choice #3
Due to liability reasons, all conference participants MUST use provided and approved charter bus transportation to and from the tour.

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