CONVENTION REGISTRATION FORM - American Council of the Blind of Virginia

First and Last name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Primary Phone *

Cell/Text

Email Address *

Confirm Email Address *

Format choice for convention materials *EmailLarge print

Check all that apply.Gluten-freevegetarianAllergies

I have an allergy to:

Transportation: Are you coming by train? *YesNo

Transportation: Do you need assistance finding transportation to the convention? *Yes. If so, contact RoseAnn.No

Hotel: Do you need a roomate for your hotel stay?YesNo

Are you Deaf or Hard of Hearing and need an accommodation during the comvention? e.g. Interpreter, ALD, SSP, etc. If yes, please describe your need.NoYes

Please describe what type of accommodation you need. e.g. Interpreter (close-vision, tactile), ALD (Assistive Listening Device), loop, SSP (Support Service Provider)

The official ACBVA photographer will be documenting our conventions, activities, and events to post on our website and social media. If you do not give permission to be included in these, let us know here.Click only if you do not want your image used.

I have read and agree to the ACBVA Convention Late Registration Policy. *Yes

I have read and agree to the ACBVA Convention Registration Refund Policy. *Yes

I will be paying: *$50 by October 3, 2025$60 after October 3, 2025Student by October 3, 2025 $25.Student after October 3, 2025 $30.Virtual via Zoom $10

Do you need financial assistance to attend convention?Yes. If yes contact RoseAnn Ashby.No

Payment method for convention registration fee, I will: *use credit/debit or PayPal payment button on confirmation page.mail a check to address on confirmation page.use Zelle (see confirmation page)call Theresa (number on confirmation page).