FULL PACKAGE - $84 Registration - Fri & Sat Socials - Training - Awards Banquet SOCIAL PACKAGE - $48 Registration - Fri & Sat Socials - Training TRAINING PACKAGE - $15** Registration - Training

JanConvention Full Package $87.00 Social Package $51.00 Training Package $18.00 Name of Attendee(s):

**All attendees including Senators and Life Members are required to pay minimum registration.

STEP 1: List name(s) of Participants:

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STEP 2: CHECK OR CREDIT CARD
a) - CHECK: Attach check payable to Virginia Jaycees.

b) VISA or MASTERCARD (cirlce one) - EXPIRATION DATE _______

CVV CODE (back of card) _____

NAME ON CARD _____________________________________________

STEP 3 - Mail it in to:

Virginia Jaycees Jan 2011 Conference
c/o Lillibet Miller Obrecht
13812 Kentucky Derby Place
Midlothian, VA 23112-6707