State Convention Registration Form | National Federation of the Blind of West Virginia

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First Name

Last Name

Country

Street Address

City

State/Province

Postal Code

Phone Number

Room Preference

Room Preference One King

Room Preference One KingOne King

Room Preference Two Queens

Number of attendees in room

Are you A voting member?

Are you a voting member: Yes

Are you a voting member: No

Agenda Format

Agenda Format Braille

Braille

Agenda Format Electronic

Agenda Format Large Print

Agenda Format Standard Print

Which chapter are you a member of

Do you need transportation?

Do you need transportation: Yes

Do you need transportation: No

Payment

Donation Fieldset

Registration Fee

Type the Registration Fee Here

Send a note with your contribution (Please indicate if this donation is in memory of someone, for a particular event, or for dues)

Payment Type

Check this if you will be paying with PayPal

Check this if you will be paying with PayPalDo you need transportation: Yes

Check this if you will be sending a check or money order.

Check this if you will be sending a check or money order.Do you need transportation: No

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National Federation of the Blind, Ahmad Shafi, President
Mailing Address
PO Box 454, Elkview, WV 25071
Phone: 304-931-9655
Email: kingshafi79@gmail.com