Virginia Tiered Systems of Supports

Exploration and Installation - Cohort #6

Completion of this form will register you for all three days. Please be sure to put all three dates below on your calendar:

Thursday, July 18, 2019 at Holiday Inn Charlottesville;
Thursday, August 29, 2019 at Doubletree Hotel by Hilton - Charlottesville; and
Tuesday, September 17, 2019 at Doubletree Hotel by Hilton - Charlottesville

Times:

Check-in - 9:00 a.m.

Session - 10:00 a.m. - 3:00 p.m.

No room block provided; to make reservations at a hotel, please click on the appropriate session date listed above. State rate is $132 plus tax; all parking is complimentary.

Name Prefix

First Name

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Last Name

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Name Suffix

For the email address, please enter your correct professional email address. Please do not duplicate an email address if registering for more than one person.

Email Address

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Employer Type

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School Division

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Other School Entity

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Agency

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Other State Agency

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VTSS-T/TAC Role

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Other VTSS-T/TAC Role

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Other Employer

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Are you affiliated with a particular school division?

Yes

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Affiliated School Division

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School

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Please enter the name of the "other" school or office in ______.

Role

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Please enter your "other" role.

Job Title

Do you have a special diet?

Do you have accessibility needs?

Other, non-dietary, accessibility accommodations.

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Photographs and/or videos may be taken at this event to be used in a photo gallery, either on the VTSS -RIC or VDOE websites, or in a display via social media sources. If you do not want to be included in photos or videos, please contact us at vtssric@vcu.edu.

Daytime Phone #

Daytime Phone Extension (if applicable)

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