* 1. Contact Information

* 2. Do you have any dietary restrictions or severe allergies?

3. Please list any additional accommodations needed

* 4. Registration fee for community partners and non-member programs is $25 payable in cash or check prior to May 15th. Checks may be made out to VNADSV and mailable to:

VNADSV PO Box 405 Montpelier, VT 05602 Attn: Ana Cimino

Please check the box below that reflects the status of your payment:

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