Registration 2022 PCB Virtual Conference and Convention Registration Form "Accelerate Your TRIP to Self-Reliance"October 27-30, 2022Registration is FREE!! Invite a friend!! We encourage you to register by October 10 to allow enough time for postal delivery of your accessibly formatted program book. If your registration is received in the office after the 10th, your program book will only be available electronically, either in Word via email or in Daisy audio download from our website. Full Name:* Address:* City:* State:* Zip Code:* E-mail: Phone (please include area code):* Requested format of your Conference ProgramBrailleLarge PrintEmailAudio/Thumb DriveConnecting to the Conference:When using a land-line phone, Zoom is a toll call unless you have an unlimited long-distance calling plan. Do you have a long distance calling plan?YesNo Do you need the toll-free number to call into the conference?YesNo Referred by a friend: Were you encouraged to attend the conference by a PCB member?*YesNo If someone did refer you, please name the person.Conference Activities:Please indicate how you would like to participate. Descriptions of each event are available on the preliminary schedule.Thursday, October 27, 2022 9:00 PM Riddle Bits (Four contestants)*I would like to be a contestantI will enjoy from the audienceI will not attendFriday, October 28, 2022 12:00 PM Newcomer's Lunch Lounge: If you are new to PCB or the PCB Conference, join the Peer Engagement Team to learn more about PCB while we get to know you a little better too.*I am a first time conference attendee and will participateI have attended other PCB conferences and want to participate in fellowshipI do not plan to attend this event 2:00 PM Improve with Improv:*I would like to actively participateI will listen from the audienceI will not attend 9:00 PM Can You Sing It? (16 or 20 contestants)*I would like to be a contestantI will participate from the audienceI will not attendSaturday, October 29, 20221:00 PM PCB Business MeetingOnly paid 2021 PCB members who are registered for the conference may attend this event. All who expect to vote should be sure to join the meeting as an individual to retain their individual PCB vote. Since we will use Zoom's hand-raising function, married couples, those using three-way calling, and others who typically share a connection should plan for accessing through their own device. Will you need toll-free calling service to access the business meeting?*YesNoSunday, October 30, 2022 3:00 PM PCB Live Auction Toll-free calling service is not being offered for this fundraiser event. We will do our best to match those without Zoom access with a peer phone partner who does have access. Please indicate your situation for the auction.*I do not have unlimited long distance calling and would need to be brought into the auction.I am willing and able to bring someone else into the auction by phone.I will attend on my own.I will not attend. Optional Demographic Information: Please check all that apply to you.I have a vision-related disability.I have a hearing-related disability.I have a physical disability.I have a learning-related disability.I do not have a disability. Would you like to purchase any 50/50 tickets to support our Room Rate Fund to subsidize the overnight rate for our next in-person conference? Tickets are $5.00 each? Please select "yes" and enter how many you would like to purchase.Yes, I want to purchase 50/50 ticketsQuantity Please consider contributing to support this year's conference. Anyone who donates at least $5 can give a community shout out in the conference program.Patron ($5)Contributor ($10)Benefactor ($25)Other Contribution Amount Other Contribution Amount: (please use whole numbers only ex. "50", no symbols) USD Complimentary Community Shout-Out: If you are contributing at least $5.00 in support of the conference, please include an upbeat shout-out to be published in the conference program. Must be 15 words or less. SAMPLE -- Congratulations! Joe and Jill Blink celebrating 25 years together! We love you J&J! - Their ChapterSAMPLE -- Going blind opened my eyes to the real beauty in people. Thanks for supporting me. - Justin Tyme Your Shout-Out: Total Payment Due:To pay online by PayPal or credit card click submit.Note: This will take you in to the PayPal screen. If you don't have PayPal, click “Guest Checkout” to enter your email address and begin the process to pay by credit or debit card. Once you submit your payment information, it will give you an opportunity to sign up for PayPal. You’ll need to click the “Not Now” button to process your payment confirmation.SubmitResetTo pay via check or money order, please click submit and then send payment to: Pennsylvania Council of the Blind, PO Box 68, Volant, PA 16156.You may also pay by calling our office at 877-617-7407.