**18^th^ ANNUAL SPECIAL EVENT REGISTRATION**

**CHAPLAIN LEADERSHIP CONVOCATION**

**December 1-4, 2003**

Please return this form to the National Chaplain Center (301/110C),
Attn: Victoria Miller,

VA Medical Center, Hampton, Virginia 23667 along with a personal check
for the sum total payable to NAVAC. (A receipt will be provided on
site**).**

**PLEASE NOTE THAT GOVERNMENT CHECKS CANNOT BE ACCEPTED.**

Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Your VAMC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Religious Denomination
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone (Work) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Emergency) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Spouse or Guest Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+--------------------------------+-----------+-----------+-----------+
| General Registration -         |           |           |           |
| **\$53**                       |           |           |           |
+--------------------------------+-----------+-----------+-----------+
|                                | Regular   | V         | Kosher    |
|                                |           | egetarian |           |
+--------------------------------+-----------+-----------+-----------+
| NAVAC Luncheon for Myself      |           |           |           |
|                                |           |           |           |
| Tuesday - **\$22**             |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| NAVAC Luncheon for Spouse /    |           |           |           |
| Guest - Tuesday - \$22         |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| Best Practices Luncheon for    |           |           |           |
| Myself                         |           |           |           |
|                                |           |           |           |
| Wednesday - **\$22**           |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| Best Practices Luncheon Spouse |           |           |           |
| / Guest Wednesday - (\$22)     |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| Award Luncheon for Myself      |           |           |           |
|                                |           |           |           |
| Thursday **- \$28**            |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| Award Luncheon for Spouse /    |           |           |           |
| Guest                          |           |           |           |
|                                |           |           |           |
| Thursday - \$28                |           |           |           |
+--------------------------------+-----------+-----------+-----------+
| **TOTAL**                      |           |           |           |
|                                |           |           |           |
| **ENCLOSED**                   |           |           |           |
+--------------------------------+-----------+-----------+-----------+

The Chaplain Field Leadership Council members should arrive on Sunday,
November 30th. All others should arrive Monday, December 1st. Since the
Convocation will end late on Thursday afternoon, many participants will
want to plan to travel on Friday, December 5, 2002.

**Completion of this registration form does NOT reserve your room at the
Radisson Hotel. The room rate is \$62.25 + tax (double or single).
Please make your reservations NOW by contacting the Hotel directly at
1-800-333-3333 or 757-727-9700. Reservation deadline is November 1st.**

The Radisson Hotel runs a complimentary Van shuttle to and from Norfolk
International Airport, but you **must call ahead** and make a
reservation to be picked up. When you arrive please go to the arrivals
side of the airport, just outside of the baggage claim area and wait for
the shuttle.