Registration: VAFB Management Development Program (MDP)

First Name

Last Name

Email Address (to receive confirmation)

Cell Phone Number

Virginia Farm Bureau Department or Role

If OTHER West Creek Department, which?

To which Cohort are you assigned?

Cohort 2

Cohort 3

I am to participate with Cohort 2 AND Cohort 3

Dietary Restrictions?

If OTHER dietary restriction, please specify.

ADA Restrictions?

If OTHER ADA restriction, please specify.

Which Session(s) will you attend?

Cohort 2/Session 1/October 6/Richmond

Cohort 2/Session 2/December 9/Roanoke

Cohort 2/Session 3/February 23/Richmond

Which Session(s) will you attend?

Cohort 3/Session 1/October 7/Richmond

Cohort 3/Session 2/December 10/Roanoke

Cohort 3/Session 3/February 24/Richmond

Will you need a hotel room?

Yes, for Cohort 2/Session 1/October 6/Richmond (Hotel stay is the night of October 5)

Yes, for Cohort 2/Session 2/December 9/Roanoke (Hotel stay is for night of December 8)

Yes, for Cohort 2/Session 3/February 23/Richmond (Hotel stay is for night of February 22)

No, I don't need a hotel room in any location.

Will you need a hotel room?

Yes, for Cohort 3/Session 1/October 7/Richmond (Hotel stay is the night of October 6)

Yes, for Cohort 3/Session 2/December 10/Roanoke (Hotel stay is for night of December 9)

Yes, for Cohort 3/Session 3/February 24/Richmond (Hotel stay is for night of February 23)

No, I don't need a hotel room in any location.