State Convention Registration Form

Contact 1
First Name
Last Name
Country
Street Address
City
State/Province
Postal Code
Mobile Number
Home Number
Chapter or Division you are a member of?
Agenda Preferred Format
Are you a current Guide Dog user?
Are you a first-time attendee?
Are you the parent of a blind/low vision child?
Are you a blindness professional?
Do you require an interpreter?
Do you require a listening device?
Are you an NFB Newsline subscriber?
If no, would you like to sign up for Newsline?
Choose your banquet meal?
Check your method of payment.
Payment
Donation Amount
Total amount you will be paying.
Type a note here for what you will be paying for Registration, Banquet, and lunches.
Payment Information
Total $ 0.00