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Name *

Date of Birth *

Address *

Select phone number type(s) *

Are you legally blind or low vision? *
Do you have a service animal? *
Can you travel independently? *
Can you self-administer medication? *
Do you have a valid passport? *
Do you have any dietary restrictions or food allergies? *

Do you require the assistance of a caregiver? *
Have you ever attended a Team BVA-sponsored event? *

Please select events that you would be interested in:


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