2009 Oklahoma Council of the Blind Convention Registration Form

Please complete the form below and check applicable conference information so we are aware of your needs

Name ____________________________________________

Address__________________________________________

City_______________ State__________ Zip____________

Work Phone ( )___________________________________

Home Phone __)___________________________________

E-Mail ____________________________________________

____ Registration $ 80.00

____ Extra Lunch Ticket

(applies to people with friends and family already

registered at the Convention. $ 20.00

____ Extra Banquet Ticket

(applies to people with friends and family already registered at the Convention) $ 30.00

____ I need a vegetarian meal at the banquet.

I need my program in

____ Large Print ____ Braille ____ Disk

Other Special Needs________________________________

Please send your registration form and payment to:

Oklahoma Council of the Blind

P.O. Box 1476

Oklahoma City, OK 73101

For more information, contact: Vicky Golightly

Convention Chairman, Home Phone: (405) 524-6227, Work Phone: (405) 522-0526 or via e-mail at vgolight@yahoo.com.

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