Registration Form for the Power of Rural 2019 Conference
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Thank you for your interest in attending the Power of Rural. To register, complete the form below, please include your credentials in your job title.
 
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Please enter the information indicated below.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

If you have any dietary restrictions/requests or food allergies, please list them below: 

 

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Are you a WYPCA Staff Member, Planning Committee Partner, Presenter, or Vendor?

Yes
No