<p> VAND Conference Registration Form</p><p>Name: Credentials:</p><p>Company/School: </p><p>Academy Member #: Email:</p><p>Address: </p><p>Town/City: State: Zip:</p><p>Full Conference fees include light fare on Thursday, breakfast & lunch on Friday, the exhibition & access to all sessions. Hotel registration & other hotel services not included. Please check the appropriate options below: </p><p>Retired Membership Type Active Academy Member Academy Non-Academy Member Member or Student Member</p><p>Registration Postmarked Postmarked On site Postmarked Postmarked Options Before 3/27 After 3/27 Before 3/27 After 3/27 or On site Full Conference ☐$150 ☐ $170 ☐ $190 ☐ $50 ☐ $180 ☐ $200 (Thursday evening + Friday)</p><p>Thursday Evening ☐ $50 ☐ $60 ☐ $70 ☐ $35 ☐ $50 ☐ $70 only</p><p>Friday only ☐ $105 ☐ $115 ☐ $125 ☐ $35 ☐ $135 ☐ $140</p><p>Help a Student: ☐ I would like to support the Annual Meeting Student Scholarship program. Add $35 to registration </p><p>$1.00 donation to Hunger Free ☐ Yes, I would like to contribute (if paying by check) Amount: Vermont Donation available on-line at Hunger Free Vermont Website Click here</p><p>Total $ (add columns) Credit Card Payment Option Credit Card payment is available online through Pay Pal. If paying through Pay Pal, please fill out this registration form and email the completed form along with your PayPal receipt to [email protected] Photography ☐Please check this box if you do not wish any photograph you are present in to be utilized for Permission promotion of VAND activities including social media, website & print. Friday Lunch Option ☐ Shaved Roast Beef with Swiss Cheese and Horseradish served with German Potato Salad Please check one. ☐ White Wine-Poached Salmon, Grilled Vegetables (Salmon is Served Cold) ☐ Vegetarian Gyro with Cucumber and Tomato Salad Each meal also includes a cup of soup. Please list any special dietary needs or allergies:</p><p>Contribute to the Silent Auction ☐ Yes, I plan to contribute to the Silent Auction. Please be sure to include your email or phone number above so we can contact you. </p>