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78th National Convention Member Registration

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78th National Convention Member Registration

Contact Information - Step 1 of 4

Vendors/Sponsors: DO NOT COMPLETE THIS FORM!

Please refer to the Convention Prospectus for registration details.

Title *

Name *

First

Middle

Last

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone Number *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Are you a BVA member? *

Yes
No

Check all that apply:

District Director
Regional Group Member
Auxiliary Member
Delegate
Alternate Delegate
Ambassador

District # *

Name of Regional Group *

Auxiliary Title *

Member Registration Fee *

Non-Member Registration Fee *

Number of guests being brought: *

Note: $150 per guest

Number of guests being brought: *

Note: $225 per guest

Guest 1 Name *

First

Last

Layout

Guest 1 Email *

Is Guest 1 an Auxiliary member? *

Yes
No

Guest 1's Dietary Restrictions (if any)

Guest 1 Auxiliary Title *

Guest 2 Name *

First

Last

Layout

Guest 2 Email *

Is Guest 2 an Auxiliary member? *

Yes
No

Guest 2's Dietary Restrictions (if any)

Guest 2 Auxiliary Title *

Guest 3 Name *

First

Last

Layout

Guest 3 Email *

Is Guest 3 an Auxiliary member? *

Yes
No

Guest 3's Dietary Restrictions (if any)

Guest 3 Auxiliary Title *

Guest 4 Name *

First

Last

Layout

Guest 4 Email *

Is Guest 4 an Auxiliary member? *

Yes
No

Guest 4's Dietary Restrictions (if any)

Guest 4 Auxiliary Title *

Guest 5 Name *

First

Last

Layout

Guest 5 Email *

Is Guest 5 an Auxiliary member? *

Yes
No

Guest 5's Dietary Restrictions (if any)

Guest 5 Auxiliary Title *

Total *

$ 0.00

Will you be bringing a service dog? *

Yes
No

What is the service dog's name? *

Do you have any dietary restrictions? *

Yes
No

Please list your dietary restrictions *

Do you or a guest(s) require the use of a wheelchair? *

Yes
No

Select which persons require a wheelchair: *

Do you require a sighted guide for offsite trips?

Yes
No

Please select your t-shirt size: *

Please select Guest 1's t-shirt size: *

Please select Guest 2's t-shirt size: *

Please select Guest 3's t-shirt size: *

Please select Guest 4's t-shirt size: *

Please select Guest 5's t-shirt size: *

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Blinded Veterans Association
BVA is a 501(c)(3) tax-exempt, non-profit organization

CONTACT US
Blinded Veterans Association
PO Box 90770
Washington, DC 20090
Phone: (800) 669-7079
Email: bva@bva.org

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HOME
ABOUT US
- Mission
- History
- Privacy
- Financials
OUR TEAM
JOIN US
- Member Relations
SUPPORT US
- Support Us
- Corporate Sponsors
PROGRAMS
- Team BVA
- VetTech
- Ambassador
- Award
- Scholarship
- Care Review
SERVICES
- Veterans Policy
- Veterans Benefits
MEDIA
EVENTS
- Calendar of Events
- National Convention
RESOURCES