2nd Annual Barry Rutherford Registration

2nd Annual Barry Rutherford Registration Form -- APRIL 22

In order to ensure you are registered for this event, please use this form until we are able to resolve our technical difficulties! Thank you in advance for your responsiveness, cooperation and support.

Please call the ACVP office at 804.639.9213 if you have any questions or need any information.

Question Title

* 1. Contact Information

Full Name *

Organization

Address

City/Town

State/Province

ZIP/Postal Code

Email Address *

Mobile Phone *

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* 2. Registrant Status

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* 3. Position/Job Title

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* 4. CEUs Required (check as many as required)

CVT

Other (please specify)

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* 5. Do you have any questions you would like to ask speakers or staff?

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* 6. How did you hear about this CE Festival?

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* 7. Do you want to keep up-to-date with ACVP News & Announcements

Yes

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* 8. Number of CEUs expected (typical cost is $10/CEU)

Please contact aviva@gpsforgrowth if you require financial assistance or support.

Clear

i We adjusted the number you entered based on the slider’s scale.

2nd Annual Barry Rutherford Registration

2nd Annual Barry Rutherford Registration Form -- APRIL 22

Question Title

* 1. Contact Information

Question Title

* 2. Registrant Status

Question Title

* 3. Position/Job Title

Question Title

* 4. CEUs Required (check as many as required)

Question Title

* 5. Do you have any questions you would like to ask speakers or staff?

Question Title

* 6. How did you hear about this CE Festival?

Question Title

* 7. Do you want to keep up-to-date with ACVP News & Announcements

Question Title

* 8. Number of CEUs expected (typical cost is $10/CEU)

Please contact aviva@gpsforgrowth if you require financial assistance or support.

Question Title

* 9. Coupon Code

Question Title

* 10. TOTAL OWED - Number of CEUs x $10

FOR NONMEMBERS ONLY -- this will be collected and processed prior to the event and confirmed via phone!

2nd Annual Barry Rutherford Registration

2nd Annual Barry Rutherford Registration Form -- APRIL 22

Question Title

* 1. Contact Information

Question Title

* 2. Registrant Status

Question Title

* 3. Position/Job Title

Question Title

* 4. CEUs Required (check as many as required)

Question Title

* 5. Do you have any questions you would like to ask speakers or staff?

Question Title

* 6. How did you hear about this CE Festival?

Question Title

* 7. Do you want to keep up-to-date with ACVP News & Announcements

Question Title

* 8. Number of CEUs expected (typical cost is $10/CEU)Please contact aviva@gpsforgrowth if you require financial assistance or support.

Question Title

* 9. Coupon Code

Question Title

* 10. TOTAL OWED - Number of CEUs x $10FOR NONMEMBERS ONLY -- this will be collected and processed prior to the event and confirmed via phone!

* 8. Number of CEUs expected (typical cost is $10/CEU)

Please contact aviva@gpsforgrowth if you require financial assistance or support.

* 10. TOTAL OWED - Number of CEUs x $10

FOR NONMEMBERS ONLY -- this will be collected and processed prior to the event and confirmed via phone!