2019 JDVAC Conference
Gaylord Texan Resort & Conference Center
February 4-6, 2019
Participant Registration Form

Step 1 of 2: Please complete the form below and click 'Continue' to initiate your participant registration.


Important Registration Information
Registration will be open from October 1, 2018 - February 4, 2019

On-site registration will only be available at the following times: Sunday, February 3rd from noon-3pm and Monday, February 4th from 7am-9am. Please consider registering online in advance.


Registration Details
Title:
First Name:   Last Name:
Address:
City:   State:   Zip:
Phone:
Email:   Personal Email:
 
Are you a: Student   Military   VA   Indian Healthcare   Other
 
Branch:

Cost: $275, Late registration: $325 (on-site)


How would you like your name to appear on the Name Badge?
(No degree or rank designators, please)
What location/city/military installation would you like listed on your name badge?
  Monday Night: Social Event

Not your average JDVAC social event! Entertainment to be determined. Mingle with friends and colleagues while enjoying good food and a cash bar.

  Tuesday Night: Apps and Innovations

Taking poster presentations to the next level! Come join us to review some of the latest research from VA and DOD presenters and spend time mingling with the various vendors to learn the latest in hearing aid applications and innovations. Door prizes, trivia games, and photo stations galore! Appetizers will be served and a cash bar will be available.

Will you be attending Wednesday lunch? Yes   No
Would you be interested in attending a Council for Accreditation in Occupational Hearing Conservation (CAOHC) Course Director Workshop either prior to or directly after JDVAC 2019? Yes   No

Please provide comments
Please indicate special dietary needs/restrictions

 

Conference Cancellation Policy: Once your registration is complete, you will be charged $75 for cancellations through 01/15/2019. No refunds will be granted after 01/15/2019.

Please also remember that if you cancel your attendance for the conference you must also cancel your hotel accommodations. If not, you will be charged for the reserved room. Confirm any cancellations with Cheryl@kdpartnersinc.net or 936-582-2565.

 


Billing Information
Name on credit card:
Address:
City:   State:   Zip:
Phone:
 
Please click here if paying by check. Checks should be addressed and sent to: KIVA Consulting, Inc. - 18445 HWY 105 West, Ste 102, Montgomery, TX 77356
Credit Card Type:
Credit Card #:
Credit Card Exp:

****You must reserve your room on the separate link. Your registration above is for the conference ONLY.****