Vermont Network Against Domestic & Sexual Violence 10th Annual Luncheon June 6th, 2014 Capitol Plaza

Thank you for registering for the Vermont Network Against Domestic and Sexual Violence's 2014 Annual Luncheon. The Luncheon will be held on June 6, 2014 from 11:30-2:30 at the Capital Plaza in Montpelier.

Registration is due May 19th. Payment for non-Network members is $25 and can be mailed ahead of time (by May 12th for processing) or payed at the door.

This year's Keynote speaker is Kit Gruelle, survivor and advocate featured in the Sundance acclaimed film Private Violence. We will also feature art by Sally Black, which can be purchased on site to support the Art for Shelter program.

Registrations questions can be directed to Dana@vtnetwork.org

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* 1. Contact Information

Name:

Agency/Organization:

Email Address:

Phone Number:

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

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* 3. Please list any additional accommodations needed, including interpreters, physical accessibility needs or other items to support your participation.

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* 4. Registration fee for community partners and non-member programs is $25 payable in cash or check prior to May 12th. Checks may be made out to VNADSV and mailable to:

VNADSV PO Box 405 Montpelier, VT 05602 Attn:Dana Paull

If you need an invoice, please contact dana@vtnetwork.org

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

I have sent a check prior to May 12th

I will pay at the door

I need an invoice and will contact Dana

I am exempt from payment because I am part of a member program