2023 PCB Conference and Convention Registration Form

"Exploring New Pathways" October 26-29, 2023Registration is FREE!! Invite a friend!!We encourage you to get your registration into the PCB office by October 9 to allow enough time for postal delivery of your accessibly formatted program book. If your registration is received in the office after October 9, your program book will only be available electronically, either in Word via email or in Daisy audio download from our website.

Name*

First

Last

Address*

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

Email*

Phone*

Requested format of your Conference Program:*

Braille

Large Print

Audio/Thumb Drive

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 27, 2023

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 participate

I have attended other PCB conferences and want to participate in fellowship

I will not attend

9:00 PM Inside Out Anagram Game (24 contestants MAX):

I would like to be a contestant

I will participate from the audience

I will not attend

Saturday, October 28, 2022

1:00 PM PCB Business Meeting

Only paid 2023 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 29, 2023

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

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.