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second annual Blind Community Unity Day
First Name
Last Name
Country
United States
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Room Preference
Room Preference One King
Room Preference One KingOne King
Room Preference Two Queens
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: Yes
Are you a voting member: No
Are you a voting member: No
Agenda Format
Agenda Format Braille
Braille
Agenda Format Electronic
Agenda Format Electronic
Agenda Format Large Print
Agenda Format Large Print
Agenda Format Standard 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: Yes
Do you need transportation: No
Do you need transportation: No
Payment
Donation Fieldset
Registration Fee
$10
$25
$50
$75.00
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Send a note with your contribution (Please indicate if this donation is in memory of someone, for a particular event, or for dues)
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Check this if you will be paying with PayPalDo you need transportation: Yes
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Check this if you will be sending a check or money order.Do you need transportation: No
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