Untitled


Warning: array_combine() [function.array-combine]: Both parameters should have at least 1 element in /usr/home/linden09/public_html/pcb1/pcbbeta/wp-content/plugins/form-maker/frontend/views/FMViewForm_maker.php on line 176
2015 Convention Registration Form

Please select "Yes" or "No" for each question when given the option.
Full Name: *
Address: *
City: *
State: *
Zip Code: *
E-mail:
Phone (please include area code):
Format: *
Pre-Registration price $10. After October 2, registration price $12.
Pre-Registration: *
 . 
I will participate in the MCCB Thursday Night Team Trivia: *
If yes, please indicate the name of the team if known:
Friday Events to sign up for:
Please note the start time of the Friday events, activities run concurrently.
Appalachian Brewing Company Tour Departs Hotel at 10:00 a.m. *

Due to limited space, this tour is first come first serve. $25 tour fee includes transportation, tour lunch (including meal, beverage and gratuity.).

Please select either one Sandwich (includes your choice of chips/fries) or 1 Salad:

Sandwich/Wrap Choices:
ALL SANDWICHES ARE SERVED WITH PICKLE SLICES AND YOUR CHOICE OF ABC’S OWN:
PCB Audio Darts Tournament - 10:00 a.m. (there is a $5 registration fee for this event): *
I am on a team: *
If Yes, please indicate the name of the team if known:
Student's Seminar - 8:30 a.m. *
Lunch can be included for $18.00. Please select your preference if you wish to purchase lunch. Would you like to order lunch? *
Assembled in a Personal Carry-Out Box; your choice of:

Sandwiches Served on Chef’s Choice of Croissant or Kaiser Roll, Chef’s Choice of Side Salad or Creamy Coleslaw, Chips, Homemade Cookie, a piece of Whole Fruit and a Bottle of Water or Soda.

Peer Exploration LowViz Guide
Braille Tournament - Presented by the Braille and Accessible Formats Committee at 5:00 p.m. *
Saturday events to sign up for:
Saturday President’s Lunch – open to chapter officers only: *
Ordering lunch is not required to attend meeting. Lunch can be included for $18.00. Please select your preference if you wish to purchase lunch. *
Sandwiches Served on Chef’s Choice of Croissant or Kaiser Roll, Chef’s Choice of Side Salad or Creamy Coleslaw, Chips, Homemade Cookie, a piece of Whole Fruit and a Bottle of Water or Soda. Assembled in a Personal Carry-Out Box; your choice of:
Saturday Banquet (your choice of):
Meals include Fresh spring mix salad , Chef’s Choice of Starch, Dessert, Vegetable including a Basket of Bread and Butter, Iced Tea and Coffee Service.Dessert Pound Cake topped with seasonal berries.
Sunday Business Breakfast All meals include assorted chilled juices, Fresh Columbian coffee, Decaf and Tea). Choose one from the below:
Include a PCB Insulated Travel Mug at the special rate of $6 or 2 for $10. Please check the first box if you would like to purchase 1 PCB Insulated Travel Mug for $6 or check the second box if you would like to purchase a set of PCB Insulated Travel Mugs for $10 and then select the number of sets you would like to purchase.
50/50 Room Rate Fund Tickets. Please check box and enter the quantity of tickets you would like below:
PCB Convention Donor:
Mobility Impairment: *
Guide Dog User: *
First Time Attendee: *
Please review your selections below. Items that do not have a cost are not shown in this section. The total cost is listed at the end.
product 1 $100
product 2 $200
$300
To pay online, click submit and you will be connected to our paypal submission form.To pay via check or cash, please click submit and then send payment to:PCB Office931 N. Front StreetHarrisburg, PA. 17102