Untitled 2015 Convention Registration FormPlease 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: *PrintBrailleCassetteEmailPre-Registration price $10. After October 2, registration price $12.Pre-Registration: * . DollarsCentsI will participate in the MCCB Thursday Night Team Trivia: *YesNoIf 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. *Yes, I want to attend the ABC TourNo, I do not want to attend the ABC TourDue 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:THE SMOKY STRUTTER - Oven-roasted turkey breast, sliced thin and layered between grilled baguette bread, with white Cheddar cheese, apple wood smoked bacon, fresh baby spinach and sliced tomato.STOUT GLAZED HAM & CHEESE PRETZELWICH - Thinly slides Black Oak ham braised in ABC Susquehanna Stout beer, then piled high on a toasted gourmet pretzel roll. Topped with melted Swiss cheese and our Brewhaus mustard.MALT HAUS SALAD - Fresh crisp greens topped with cucumbers, red onion, cherry tomatoes, black olives, Cheddar-Jack cheese and croutons. Choose one of ABC’s signature dressings.WEDGE SALAD - A fresh, crisp wedge of Iceberg lettuce topped with crumbled bleu cheese, chopped apple wood smoked bacon and diced red onion Served with ABC bleu cheese dressing. ALL SANDWICHES ARE SERVED WITH PICKLE SLICES AND YOUR CHOICE OF ABC’S OWN:HOMEMADE BREWHAUS CHIPS FRIESPCB Audio Darts Tournament - 10:00 a.m. (there is a $5 registration fee for this event): *Yes, I want to participate in the PCB Audio Darts TournamentNo, I do not want to participate in the PCB Audio Darts TournamentI am on a team: *YesNoIf Yes, please indicate the name of the team if known:Student's Seminar - 8:30 a.m. *YesNoLunch can be included for $18.00. Please select your preference if you wish to purchase lunch. Would you like to order lunch? *Yes, I will order lunch at the Student Seminar for $18.00No, I will not order lunch at the Student SeminarAssembled in a Personal Carry-Out Box; your choice of: Ham & American CheeseTurkey & SwissRoast Beef & CheddarVegetarian Option: Roasted Vegetable & Hummus on Kaiser 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 Guide8:30 a.m. (Morning Session)1:30 p.m. (Afternoon Session)Braille Tournament - Presented by the Braille and Accessible Formats Committee at 5:00 p.m. *YesNoSaturday events to sign up for:Saturday President’s Lunch – open to chapter officers only: *YesNoOrdering lunch is not required to attend meeting. Lunch can be included for $18.00. Please select your preference if you wish to purchase lunch. *Yes, I would like a meal at the Saturday President's Lunch for $18.00No, I do not want a meal at the Saturday President's LunchSandwiches 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:Ham & American CheeseTurkey & SwissRoast Beef & CheddarVegetarian Option: Roasted Vegetable & Hummus on KaiserSaturday Banquet (your choice of):Saturday Banquet Chicken Bruschetta: Boneless breast of chicken, sauteed with tomatoes artichoke hearts, basil, garlic, and mozzarella. Served with farfalle pasta. ($30.00)Saturday Banquet Prime Rib of Beef: Roasted Prime Rib with au jus. Served with horseradish cream. ($33.50)Saturday Banquet Roasted Garlic andHerb Pasta Primavera: Orecchiette pasta with flame roasted vegetables tossed in a garlic cream sauce. ($27.50)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:Sunday Breakfast Option 1: Continental Breakfast - assorted pastries, muffins, Danish and fruit preserves and butter. ($10.75)Sunday Breakfast Option 2: Basic Egg Breakfast - scrambled eggs, breakfast potatoes and bacon. ($14.75)Sunday Breakfast Option 3: Vegetarian Options - Vegetable Omelet filled with shredded cheese, grilled peppers, and onions. Served with breakfast potatoes. ($14.75)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.Yes, I want 1 PCB Insulated Travel Mug for $6.00Yes, I want a set of PCB Insulated Travel Mugs for $10.00Quantity50/50 Room Rate Fund Tickets. Please check box and enter the quantity of tickets you would like below: Yes, I want 50/50 Room Rate Fund TicketsQuantityPCB Convention Donor:Patron ($5)Contributor ($10)Benefactor ($25)Mobility Impairment: *YesNoGuide Dog User: *YesNoFirst Time Attendee: *YesNoPlease 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 $100product 2 $200$300To 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. 17102type_submit_reset_64SubmitReset