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

First Name

Last Name

Country

Street Address

City

State/Province

Postal Code

Phone Number

Which Chapter Are You A Member Of?

Room Preference

Number of attendees in room

Preferred Agenda

Are You A Voting Member

Do You Need Transportation

Payment

Donation Fieldset

Registration Amount

Type in 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)

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