NFB of NC State Convention Registration

Important Note

All online registrations must be received on or before Friday, September 8th.

Required fields are marked with the * character.

Personal Information

First Name*:
Middle Initial:
Last Name*:

Contact Information

Address line 1*:
Address line 2:
City*:
County*:
State*:
Zip Code*:
Home Phone Number (example: 123-456-7890)*:
Cell Phone Number (example: 123-456-7890):
Email Address*:
Chapter Affiliation (List MAL if none)*:
Is your Chapter paying your Registration*:
Yes
No
Preferred Program Media*:
Large Print
Braille

Registration Details

Convention Online Registration $15.00*:
Yes
No
Banquet Ticket $32.00*:
Yes
No
Vegetarian Meal:
Yes
No

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Disclaimer: Copyright 2017 NFB of NC, all rights reserved. NFB of NC is not responsible for any damages, real or perceived, caused by the use of this form.
For help, contact Sharon Weddington at (704) 302-7308.