ADVIP Conference Registration by Mail

This form may be used for registration payments by mail.
For online registrations using PayPal or credit / debit card, please visit this page.

August 29, 2020 International Conference

Registration

Please complete the information below to register for the conference. A copy of the form will be mailed to the email address you supply.

Print this emailed form and mail with check or money order payable to ADVIP to:

John Hamel, ADVIP Conference Chair
28 Upper Oak
San Rafael CA 94903
U.S.A.
If you have any questions, please email johnmhamel@comcast.net
Name*
First Last
Organization
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Number of Attendees*
Check one:*
- Conference Registration - Early Bird (before June 1) - $140.00
- Conference Registration - $160.00
- Conference Registration - Current ADVIP Member - $125.00
- I have already registered ($0)
Continuing Education Credits*
- Early Registration CEU - $45
- At the Door CEU - $55
- No CEU
If you would like to earn CEU for attending the conference, please check the appropriate box and this will be added to your registration fee.
Total
$0.00

Association of Domestic Violence Intervention Providers