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For more information: Contact Suzanne Ankrum at
suzanne@vcnva.org or 804-644-0283.
Register:
Print this page and mail with check to:
Virginia Conservation Network
422 E Franklin St, Suite 303
Richmond, VA 23219
please mail registrations by January 14, 2008
or
Register online by clicking on this link
__________________________________________________________________________________________
REGISTRATION FORM
Registration ($15)*:_____
Additional Donation:_____
Total: _____
*includes lunch and materials, additional donations are appreciated
Name:_________________________________________________________
Organization (if applicable):_________________________________________
Phone:(_____)_____________________
Address:__________________________
City:_____________________________
Zip:______________________________
E-mail:____________________________
My Senator is:_____________________________________
My Delegate is:____________________________________
My Appointment Times are**:
Time:_________Delegate:_____________________
Time:_________Senator:_____________________
** if you have not made your appointment at the date of registration please e-mail that information as soon as possible to suzanne@vcnva.org
Carpool (Check all that are applicable):
__________ Yes - I am driving and have _______ number of extra spaces in my car
__________ Yes - I am interested in finding a ride to Lobby Day
_____________________________________________________________________________
Virginia Conservation Network
Virginia’s only statewide network of over 115 environmental,
conservation, & community groups working for
a better future. 422 East Franklin Street, Suite 303, Richmond, VA 23219, 804-644-0283, vcn@vcnva.org
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