Virginia Grain Producers Association :: 2012 Annual Conference Registration Form

ATTENDEE REGISTRATION FORM

2012 Virginia Grains & Soybean Annual Conference

To Register: Complete the form below, including your payment method. Click "SUBMIT" to submit your registration form.

Email Ben@VirginiaGrains.com For a Printable Registration Form

Individual Registration

Registration - $15 (limited number available)

Please make checks payable to "Virginia Soybean Association" and remit to:

Virginia Soybean Association
151 Kristiansand Drive, Suite 115
Williamsburg, VA 23188

Have other questions? Contact Us!

VA Grain Producers Association
Katie Frazier
Katie@VirginiaGrains.com
PH: 804-648-6299 x5835
FX: 804-643-4490

VA Soybean Association
Dick Atkinson
Dick@VaSoybean.com
PH: 757-564-0153
FX: 757-564-8165

Name *
Daytime Phone *
Email Address *
Names of Attendees *
Total Number of Attendees *
Registration Total $ Due ($15 per person) *
Payment Method *	Please expect my check in the mail within 3-5 business days. I will bring my pre-registration fee with me on February 23rd. Credit Card - Please Contact Katie@VirginiaGrains.com