2026 CONVENTION REGISTRATION FORM - American Council of the Blind of Virginia

2026 ACBVA Convention

All information submitted will be kept confidential and used solely for ACBVA Convention planning purposes. Your registration is not complete until we receive your payment.

First and Last name *

Street Address *

Apartment, suite, etc

City

State *

State

Zip code *

Best Contact Phone *

Phone for Texts

Email Address *

Confirm Email Address *

Registration Type *

Choose which meals you will attend- Select all that apply. (These meals are included in your registration fee.)Friday SocialSaturday lunchSaturday Banquet Dinner

Select Banquet Dinner entree'

Dietary Needs: Check all that apply.Gluten-freevegetarianAllergies

I have an allergy to:

Transportation & Assistance (Check all that apply.)Need a ride from train stationNeed assistance arranging transportationNeed financial assistance to attend (Applicant will be contacted separately)Need a roommate

Do you need an accommodation during the convention if you are Deaf or Hard of Hearing? e.g. Interpreter, ALD, SSP, etc. If yes, please describe your need.Yes

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

ACBVA Registration & Liability Agreement *I attest that I have read and agree to all of the provisions in the ACBVA Registration & Liability Agreement.

ACBVA Convention Policies *I attest that I have read and agree to all of the provisions in the ACBVA Convention Policies.

Voluntary Emergency Medical InformationVoluntarily list any medical conditions, allergies, mobility limitations, Emergency Contact name and phone, or other information that may assist emergency responders, if necessary.

Payment: *I will be paying $75I will be paying $90I will be paying $55 Student (age 25 or under)I will be paying $25 Virtual Registration (Zoom)

Payment Method for the Convention Registration Fee *I will use credit/debit or PayPal payment button on confirmation page.I will mail a check to address on confirmation page.I will use Zelle (see confirmation page)I will call Theresa (number on confirmation page).