[Seniorresources] Conference Registration Form

[Sally Camp]

CONFERENCE REGISTRATION FORM

 

Responding to Elder Abuse and Domestic Violence in Later Life:

Safety, Accountability, Services, and Collaboration

 

August 24 and 25, 2006


Doubletree Hotel Richmond Airport, Sandston, Virginia


 

Use the TAB button to advance through this form.  If you are registering
by email and mailing your payment separately, save this file using your
name as the filename, and attach the file to an email addressed to
tmliveng at vcu.edu. 

 

Name:                  

 

Title:                                 

 

Agency:                          

 

Address:                         

 

Phone:                

 

FAX:                     

 

E-mail:                 

 

Breakout sessions attending: (choose one from each pair)        

 1 or  2        3 or  4        5 or  6        7 or  8        9 or  10
11 or  12

 

Special Needs? Please specify:      

 

Registration: Early registration is $40/person and ends on August 17,
2006.  Late registration is $50/person, if space allows, and ends on
August 22.  Seating is limited.

 $40 Early Registration                 $50 Late Registration 

 

Payment of Conference Fee:

 Enclosed

 My agency will process a check.  P.O. #:        (VCU Fed. ID #:
54-6001758)

 

Checks should be made payable to the Virginia Center on Aging.  Your
payment (plus registration if it was not sent by email or fax) should be
mailed to:

Virginia Center on Aging

Attention: Tara Livengood

P.O. Box 980229

Richmond, VA 23298-0229

Phone: (804) 828-1525; FAX:  (804) 828-7905

 

Accommodations: A block of rooms has been reserved at the Doubletree
Hotel Richmond Airport at a rate of $96/night.  Please make your own
room reservation by calling 1-800-222-TREE (8733) and requesting the
Elder Abuse Conference rate. Room reservations must be made by August 2,
2006 to receive the conference rate. 

 

 

 

Sally Camp 
Services Coordination Project 
Senior Connections 
24 E. Cary Street 
Richmond, VA 23219 
804-343-3058 
scamp at youraaa.org 

 

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