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).

4/24
Breakfast / 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