If you prefer to print and fill out this form and mail. Choose print page.
Include our organization as a sponsor of the 2017 Virginia Community Viability Institute!
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Name of Organization:
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Sponsorship Level: $
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Please complete the fields below identifying who will represent your organization and if you are hosting an exhibit.
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Registration 1:
Name
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Company/
Farm Name
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Telephone Number
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Email Address
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Registration 2:
Name
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Company/
Farm Name
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Telephone Number
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Email Address
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Total Sponsorship Enclosed: $
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___Yes, Our organization will have an exhibit.
___ Requires electricity ___Does not require electricity
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Please enclose a check or money order made payable to
“Treasurer, Virginia Tech” and mail to:
Dr. Martha A. Walker, Virginia Cooperative Extension
150 Slayton Avenue - Danville, VA 24540
Virginia Cooperative Extension is unable to accept payment by credit card.
If you prefer to pay by check you may register on-line.