Form Development – American Council of the Blind of Texas

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone

Please enter your Cell phone.

Email *

Email

Confirm Email

Are you a TWC employee

I am a TWC employee and TWC will pay for my registration.

Are you a TWC employee?

TWC client

I am a TWC client and TWC will pay my registration fee.

Are you a TWC client?

Are you an ACB member

I am an ACB member

Are you an ACB member

Please choose your chapter. *

What chapter do you belong to?

Is this your first ACBT Annual conference

This is my first time to participate in the ACBT Annual conference.

Do you plan to attend the first timers' reception??

Yes, I plan to attend the First Timers’ Reception Friday evening, August 28th beginning at 6:30 PM.

Do you plan to attend the first timers’ reception??

Please choose your program format. *

Program Format

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Pay By Check

I will pay by check.

Do you want to pay by check?

Registration

Conference/Convention Registration Fee – Includes all sessions. – $ 25.00

Donation per ticket(s) for Ultimate Grill Package Drawing.

One Raffle Ticket – $ 10.00
Two Raffle Tickets – $ 20.00
Three Raffle Tickets – $ 30.00
Four Raffle Tickets – $ 40.00
Five Raffle Tickets – $ 50.00
Six Raffle Tickets – $ 60.00

Total

$ 0.00

Is this form complete? *

I have reviewed this form and it is complete.

Is this form complete?

Forms Development Area

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