Registration 2019 PCB Conference October 17-20, 2019 2019 PCB State Conference Registration Form Early Registration price is $12. After October 4 price is $15. Full Name:* Address:* City:* State:* Zip Code:* E-mail:* Phone (please include area code):* Please select your preferred format:*Large PrintBrailleAudio/Thumb DriveEmailThursday October 17, 2019 9:00 PM The Conference Program & Planning Team Presents: Believe or Bust? Sponsored by the York County Chapter. No fee to participate. Please select one option:*I will playI will enjoy from the audienceI will not attend the eventFriday October 18, 2019 7:30 a.m. Getting to Know Us First-Timer's Breakfast. Sponsored by the Lehigh Valley Chapter. The Peer Engagement Team invites all who are attending the PCB Conference for the first time to join us for a complimentary continental breakfast, and an opportunity to learn more about each other. *I am a first-timer and will attend the breakfastI am on the Peer Engagement Team or PCB Board of Directors and will attend the breakfastI will not attend the breakfast 9:00 am - 12:00 pm Audio Darts Double Features, sponsored by the Golden Triangle Chapter. 9:00 AM Audio Darts Instructional Throwing Clinic: Registration fee: $2.00. *I will participate in the Audio Darts Instructional Throwing ClinicI will not participate in the Audio Darts Instructional Throwing Clinic 10:00 AM The 2019 Audio Darts Tournament for Experienced Throwers. Registration fee: $5.00.*I will participate in the Audio Darts Tournament for Experienced ThrowersI will not participate in the Audio Darts Tournament for Experienced Throwers 10:15 AM Audio Described Movie (TBD), sponsored by the Golden Triangle Chapter. Registration fee: $5.00.*I will attend the Audio Described MovieI will not attend the Audio Described Movie 3:45 PM - 4:30 P.M. Concurrent Breakout Sessions (Please indicate which session you will attend)*Introduction to the AccessiDocs Project, Tony SwartzPeers challenging beliefs: Vision Loss TeamI will not participate in a breakout sessionIntroduction to social media, Rose Martin - To ensure this workshop is geared to the appropriate audience, please answer the following questions: Do you have a laptop, tablet, or smart phone at home?YesNo Do you have any social media accounts?YesNo If not, are you interested in creating one?YesNoSaturday October 19, 2019 7:00 PM The PCB Saturday Night Banquet, sponsored by the Hank Bloomberg Chapter. Each meal includes fresh spring mix salad (two dressing choices - Ranch and Italian), your choice of entree, Chef's choice of vegetable and starch, rolls, Granny Smith apple pie with caramel, iced tea, and coffee. Please note: The pasta meal does not include same starch or vegetable served with the chicken or fish meal. Please select an entree:*Chicken Piccata - A chicken breast in a lemon butter cream sauce ($30)Spinach and Shrimp Tilapia topped with a light butter sauce ($31)Toasted Garlic and Herb Pasta Primavera Orecchiette ($27)I do not want a banquet mealSunday October 20, 2019 8:30 AM PCB Breakfast Business Meeting sponsored by Philadelphia Regional Chapter. Choose one if you wish to purchase breakfast. $14 for the Continental Breakfast or $19 for the Traditional Breakfast or Vegetable Omelette.*Continental - Freshly baked muffins and Danish, butter and preserves, chilled assorted juices, fresh Columbian coffee, decaf, and tea.Traditional Breakfast - Basket of toasted English muffins on each table. Small bowl of seasonal fruit, fluffy scrambled eggs, seasoned breakfast potatoes, bacon strips, assorted chilled juices, fresh Columbian coffee, decaf, and tea.Vegetable Omelette - Basket of English muffins on each table. Small bowl of seasonal fruit, vegetable omelet filled with shredded cheese, grilled peppers and grilled onions, seasoned breakfast potatoes, assorted chilled juices, fresh Columbian coffee, decaf and tea.No Meal RequestedConference Mentor This year the Peer Engagement Team would like to have experienced conference attendees be mentors for first-time conference attendees. These buddies would provide assistance with getting oriented to the hotel, introducing new peers to others who may share similar interests or experience or just lending some support when needed during the conference weekend. *I am an experienced attendee and would like to offer my assistanceI am a first-time attendee and would like a conference mentorI do not wish to participate in this endeavorPCB Signature Glass from Loving Touch Connection. Available in two glass styles, this design features the PCB logo and the signature phrase: "Peers Challenging Beliefs" in print and raised Braille. Conference introductory price: $18.00 each. PCB Signature Glass from Loving Touch Connection: 16-ounce ice tea glassI want a 16-ounce ice tea glassI do not wish to purchase an ice tea glassQuantity PCB Signature Glass from Loving Touch Connection: 21-ounce stemless wine/juice glassI want a 21-ounce stemless wine/juice glassI do not wish to purchase a wine/juice glassQuantity PAGDUS Saturday Morning Breakfast. Rough start to your Saturday morning? We're here to help. Stretch your legs and paws on a short walk to a local restaurant close to the Crowne Plaza, the conference hotel. Grab a cup of coffee or a bite to eat with peers of the Pennsylvania Guide Dog Users and Supporters, the newest Chapter of PCB. All humans and canines are welcome whether or not you are a guide dog handler. Because this is not a sponsored event, all individuals are responsible for their restaurant purchases. Details and time will be shared in the PCB Advocate and all the PCB media. Please indicate whether you plan to attend so we can have an accurate count for the reservation.*I will attend the Saturday morning PAGDUS breakfastI will not attend the Saturday morning PAGDUS breakfast 50/50 Room Rate Fund Tickets: $5 each. Please enter how many you would like to purchase.I want 50/50 Room Rate Fund TicketsQuantity Please consider making a contribution to support our annual conference. PCB Conference Donor:Patron ($5)Contributor ($10)Benefactor ($25) Total: I am a First Time Attendee:*YesNo I have a mobility impairment:*YesNo I am a Guide Dog User:*YesNo I need a handicapped accessible room and have reserved it with the hotel:*YesNo I use a wheelchair or scooter and will be bringing it with me to the conference.*YesNo For those traveling into Harrisburg via bus or train, please indicate your expected arrival time/date. This information will help us schedule volunteers to assist members at the station.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 paymentto: PCB Office 931 N. Front Street, Harrisburg, PA. 17102SubmitReset