Register for the WVASFA Annual Conference using the form below:

Name of County Contact (For Multiple Attendees)
First Name	*
Last Name	*
Title	*
E-mail Address	*
Cell Phone	*
County	*	-- Select One -- Barbour Berkeley Boone Braxton Brooke Cabell Calhoun Clay Doddridge Fayette Gilmer Grant Greenbrier Hampshire Hancock Hardy Harrison Jackson Jefferson Kanawha Lewis Lincoln Logan Marion Marshall Mason McDowell Mercer Mineral Mingo Monongalia Monroe Morgan Nicholas Ohio Pendleton Pleasants Pocahontas Preston Putnam Raleigh Randolph Ritchie Roane Summers Taylor Tucker Tyler Upshur Wayne Webster Wetzel Wirt Wood Wyoming
PO / Check Number ** You will be invoiced after conference **
Number Attending Monday Session	*
Number Attending TuesdaySession	*
Number of Attendees ** TOTAL NUMBER Attending from County **	* TOTAL NUMBER OF INDIVIDUAL ATTENDEES
@ $75.00 per Person equals
Registration Fee
Security Code	*