WCB Convention Registration Form November 5-7, 2009

Please fill in the requested information and check those items that apply to you. Registration is not complete or guaranteed until payment is received. One registrant per form, please.

Last Name First Name * Please enter your name here.
Address * Enter your street address here.
City, State, Zip * The city and state you liv in plus your zip code
Your phone number * Please enter your phone number here.
Your email address * Please enter your email address here.
Preferred convention program format * Please select one of the following formats for your convention program.BrailleLarge PrintCassetteNone, I will download it from the internet
Registration postmarked by 10/15/09 * Registration cost. Please select one option.Registration only (no meals included) - $10Registration with Banquet only - $45Registration with Meal Package (includes up to five meals) - $90
Please select the meal you plan to attend on Friday November 6 2009 Breakfast Selection of meals you will be attending.First Timer Breakfast (For first time WCB convention attendees & their guests.)WCB Presidents’ Breakfast (For presidents only.)WCB General Breakfast
Friday November 6 Awards Luncheon Selection of meals you will be attending.WCB Awards Luncheon
Vegetarian option for Friday November 6 Awards Luncheon Are you requesting a vegetarian meal? Indicate yes or leave blank.
Please select the meal you plan to attend on Saturday November 7 2009 Breakfast Selection of meals you will be attending.WCB General BreakfastGDUWS Breakfast/Business Meeting (Open to guide dog users and friends.)
Please select the meal you plan to attend on Saturday November 7 2009 Lunch Selection of meals you will be attending.WCB General LunchGDUWS Lunch & program (Open to guide dog users and friends.)
Vegetarian option for Saturday November 7 2009 Lunch Are you requesting a vegetarian meal? Indicate yes or leave blank.
Saturday, November 7, 2009 Banquet Selection of meals you will be attending.WCB Annual Banquet
Vegetarian option for Saturday, November 7, 2009 Banquet Are you requesting a vegetarian meal? Indicate yes or leave blank.
To assist us in preparing for our breakout sessions, please check the ones you plan to attend on Friday at 1:30pm Please select the break out group you are planing to attend Friday at 1:30 p.m.Extracurricular Activities For Your ChapterDiabetic Concerns & Updates (sponsored by the WCB Diabetic Support Group)Regulations of Paratransit & how to file a complaintI plan to visit exhibits
Breakout sessions taking place at 3:00pm Please select the break out group you are planing to attend Friday at 3:00 p.m.Being proactive in your Job searchIntegrating into community exercise programsAccessing digital booksI plan to visit exhibits
Columbia River exhibition If you would like to tour the Columbia River exhibition of history, please note: space is limited to the first 20 people & the tour will take up Friday afternoon.Tour, 11/6/09, 1:15 p.m. - $6
Please check below all items which apply to you:I will need an assistive listening deviceI will be traveling with a guide dogI plan to perform in the Talent ShowI am a vendor exhibiting at conventionI am a first time attendeeI am interested in becoming a lifetime member of WCB for a one-time cost of $100I am a member of WCB
I have other special accommodation needs. (Please explain) If you have other special accommodation needs please provide information here.
Total amount enclosed (Please make check or money order payable to the Washington Council of the Blind). Mail completed form and payment to: WCB PO. Box 1085 Tracyton, WA 98393-1085 * Please indicate the amount of money to be enclosed with your application.