2024 PCB Conference and Convention Registration Form - Pennsylvania Council of the Blind

Name*

First

Last

Address*

Street Address Street Address Line 2 City State Postal / Zip Code

Email*

Phone*

Conference Programs will be sent via email daily as registrations are received.

Connecting 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 an unlimited long-distance calling plan?

Yes

Do you need the toll-free number to call into the conference?

Yes

Referred by a friend: Were you encouraged to attend the conference by a PCB member?

Yes

If someone did refer you, please name the person so we can enter them to win a prize.

Conference Activities: Please indicate how you would like to participate. Descriptions of each event can be found in the preliminary schedule.

Friday, October 18, 2024

9:00 PM "Who Said This?": A Famous Quotes Game/Competition among people who pay attention to who says what

I would like to be a contestant

I will participate from the audience

I will not attend

Saturday, October 19, 2024

1:00 PM PCB Business Meeting

Only paid 2024 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 other 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?

Yes

Sunday, October 20, 2024

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 plan to attend on my own

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 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

I am a first-time attendee to the conference

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.

Select the number of tickets you wish to purchase: (Note: Quantity remains set at 1, but you will not be charged unless you select "I wish to purchase tickets".)

Quantity

General Conference Support: Please consider contributing to support this year's conference. Anyone who donates at lease $5.00 can give a community shout-out in the conference program. (If donating a different amount than listed, please see the next question.)

I would like to support the conference with the following amount:

USD

Complimentary Community Shout-out: If you are contributing at least $5 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 Chapter

Going blind opened my eyes to the real beauty in people. Thanks for supporting me. - Justin Tyme

Your Shout-Out:

Total Due:

Upon clicking "Submit" you will be taken to the PayPal payment screen. If you wish to submit a check or money order, please make your payment payable to Pennsylvania Council of the Blind, and mail to: Pennsylvania Council of the Blind, PO Box 68, Volant, PA 16156. You may also pay by phone by calling our office at 877-617-7407.