Goochland/Powhatan Drinking Water Clinic September 2018
Please fill in the blanks below and complete your registration by either mailing in a check for $55.00 or by stopping by the Goochland or Powhatan Extension Offices at:

Goochland Extension Office                      OR                      Powhatan Extension Office
1876 Sandy Hook Rd.                                                            3910 Old Buckingham Road
 P.O. Box 20                                                                              Powhatan, VA 23139
Goochland, VA 23063                                                              
       
Note:  Please refer to the Goochland or Powhatan flyer for specific information on the kickoff meeting in the respective counties.   Samples kits are $55.00 each for those who want to test more than one well or multiple tests of the same well before and after a filtration system.  Please make your check payable to the "Treasurer of Virginia Tech" *There is a $50 returned check fee*
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First Name *
Last Name *
Phone *
E-mail
Street Address (Street, City, State, Zip) *
County (which you plan to pick up and drop off your sample kit) *
Number of Sample Kits Requested *
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