Name (as it will appear on badge):
Grantee/Organization:
City:
State:
Zip:
Phone (include area code):
FAX (include area code):
Email address:
Position in Head Start Program:
Do you require any special services?
Physically Handicapped Special Dietary Need
Brief description:
Registration fees: $150. Late fee of $50 per person applied after July 24. Registration due July 24, 2009.
Please send registration fees to: Virginia Head Start Association, P. O. Box 876, Lynchburg VA 24505.
NOTE: If you mail them after July 1, mail them to P. O. Box 441 Woodstock, VA 22664 Note: Conference will begin at noon on August 11 and end at 3 p.m. August 12. Co-sponsored by the Virginia Head Start Association, the Head Start State Collaboration Office, and the Head Start State-Based T/TA Office.
