NATIONAL FEDERATION OF THE BLIND OF ARIZONA

68th Annual Convention

September 12 – 14, 2012

PRE-REGISTRATION FORM

NAME:
ADDRESS:
CITY: STATE: ZIP:
HOME PHONE: WORK: CELL:
EMAIL ADDRESS:

Please indicate the number of registrations or tickets you need for EACH item:

ItemNumberTotal $
Registration ($20.00, $25 at the door) Number: Total $
Plated Lunch – Friday ($15.00) Number: Total $
Box Lunch-Saturday ($15.00) Number: Total $
Banquet-Saturday ($40.00) Number: Total $
Meals & Registration Total Total Number: Total $

Meals will be for sale at the time of Registration but NOT sold AT MEAL TIME

PLEASE INDICATE IF AN ALTERNATIVE MEAL IS NEEDED. Yes. No.

If you answered "yes," please describe your alternative meal requirements:

Pre-Registration cut-off date: 8/31/14

Please make checks payable to NFBA and mail this form with your remittance to:
National Federation of the Blind of Arizona
Attn. Sharonda Greenlaw
1216 E. Vista Del Cerro Dr., Apt #1112
Tempe, AZ 85281
(602) 281-5955
Email: sbgreenlaw (at) gmail.com (please mention NFBA in subject line)

You may also pay through PayPal at www.az.nfb.org or with a credit card at convention, so please fill out this pre-registration form.

HOTEL Pre Registration Cut Off date 8/27/14

Sheraton Airport Hotel
1600 S. 52nd Street
Tempe, AZ 85281
480-967-6600 or
Reservations: 888-627-8960
Rate: $84.00/night plus tax (Includes breakfast)

Do you need transportation to the convention? Yes. No.

Donations may be made payable to National Federation of the Blind of Arizona and mailed to: 9014 E. Bellevue St. Tucson, AZ 85715