RSVP for VABDF & HACA Advocacy Education Summit: An educational weekend for the whole family!
June 27-28, 2026 in Richmond, VA
Attendee Information
Please fill name and contact information of attendees.
Your Name
*
First Name
Last Name
Email Address
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Physical Address (NO P.O. Box)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Let Us Know How You Heard About This Event.
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Referred by HTC.
Referred by other healthcare provider.
Referred by friend or family member.
Recently moved to the area.
Internet Search.
Social Media.
Referred by HACA.
Other
How many people (including yourself) will be attending?
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1
2
3
4
5
GUEST INFO: Please type the first and last name, age, and their relationship to you. If you do not have anyone to add please type "N/A"
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Do you or anyone in your group have any dietary needs and/or restrictions that we should be made aware of? If so please list below, if the answer is "NO", write "N/A".
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Do you or anyone in your group have any mobility needs that will require assistance?
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Yes
No
Maybe
Will you need overnight accomodations on Saturday, June 27?
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Yes, and I will need VABDF/HACA to pay.
Yes, and I will be self-pay.
No, I do not need overnight accomodations.
Do you or anyone in your group require an ADA compliant room? If the answer is "NO", write "N/A".
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Are you interested in joining VABDF/HACA for an educational dinner on Saturday, June 27?
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Yes.
No.
Maybe.
Are you interested in joining VABDF/HACA for the Community Event at TopGolf Richmond on Sunday, June 28?
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Yes.
No.
Maybe.
PHOTO RELEASE: I authorize and permit VABDF and HACA to use my photograph, voice and/or likeness, with or without my name or the name of the person for whom I am the parent/guardian, in its sole discretion as it sees fit, free and clear of any claim whatsoever on my part, and without compensation.
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I have read and YES I agree.
I have read and NO I do not agree.
Submit
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