Virginia Damage Prevention Conference 2018
Supported by the
State Corporation CommissionDivision of Utility and Railroad Safety
and
Virginia Utility Protection Service, Inc.
April 24 – April 26, 2018
Please fill out a separate registration form for each individual who will attend the conference.
Attendee Name: ______Nickname/Preferred Name: ______
(This will appear on your name tag)
Company Name: ______
Address: ______
City: ______State: ______Zip: ______
E-mail: ______Phone: ______
Registration fee for the entire conference(includes meals noted below):
Before March 16, 2018:$200.00☐
Before March 30, 2018:$225.00☐
Before April 20, 2018:$275.00☐
WALK-IN $350.00☐
Make Checks Payable to: Virginia Safety Conference (We are unable to accept credit cards)
Rooms are being held at the Hilton Garden Inn Virginia Beach Oceanfront
3315 Atlantic Avenue, Virginia Beach, VA 23451 phone: (757) 305-9001,
at the government rate of $99.00 per night, until April 2, 2018 or until sold out.
For reservations call 1-800-445-8667 (1-800-HILTONS) and reference the Damage Prevention Conference or
You are responsible for making your own reservation.
Please indicate your attendance as appropriate (meals are covered by your registration fee).
4/24Breakfast / 4/24
Lunch / 4/24
Reception / 4/25
Breakfast / 4/25
Lunch / 4/25
Reception / 4/26
Breakfast
☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ /
Please note any special dietary needs: ______
PLEASE RETURN WITH REGISTRATION FEE:Please provide your preferred shirtsize:
Attn: Jennifer FisherMen: S ☐ M☐ L☐ XL ☐ 2X ☐ 3X ☐
Division of Utility and Railroad SafetyOther: ______
State Corporation Commission
P.O. Box 1197, Richmond VA 23218-1197Women: S ☐ M☐ L ☐ XL ☐ 2X ☐ 3X ☐
ther: ______
Fax: (804) 371-9484
If you have any questions, please contact Renée Salmon at (804) 371-9947,
or by email at