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Contact Information
The information you provide on this registration form will remain the property of FVPLS Victoria and will not be shared with anyone else.
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
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*Consent to take and use photographs/images: You acknowledge and consent to photographs and electronic images being taken of you during the Workshop. You acknowledge and agree that such photographs and electronic images are owned by FVPLS Victoria and FVPLS Victoria may use the photographs for promotional or other purposes without your further consent being necessary. Further, you consent to FVPLS Victoria using your image, likeness and participation in the Workshop, at any time, by any form of media, to promote FVPLS Victoria. If you wish to revoke this consent and opt-out from having your image taken during the Workshop or subsequently used by FVPLS Victoria, you must notify FVPLS Victoria staff upon arriving at the Workshop.

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If your having issues submitting this form online, please print registration

form and send via email/fax: Printable Registration Form