National Association
of County Veterans Service Officers

Basic Benefits Course Registration

Basic Benefits Registration

Complete all fields below with the attendee's information

^*First Name:

^*Last Name:

^*Your Position:

^*Office Name:

^*Address:

^*City:

^*State:

-- Select a State -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota North West Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Yukon Territory

^*Zip Code:

^*County Name:

^*Phone:

Fax:

^*Email:

^*Are you a:

CVSO
Employed by a county
State Service Officer
Employed by a state
Volunteer
Other (provide explanation)

^*Class Fee:

-- Select One -- $350.00 Members $500 Non-members

^*I Understand An Invoice Will Be Sent To Me:

Yes
No

Feedback / Message:

^*Security Key: