American Council of the Blind of Oregon
American Council of the Blind of Oregon
62nd Annual Convention October 14-16, 2016
REGISTRATION FORM
Registration forms will be sent to members by email when possible. A hard copy will be mailed to those without email and to all Chapter Presidents. If you wish to receive a hard copy, please ask your Chapter President.
Preregistration Deadline: September 24, 2016
Please complete entire registration packet
NAME ______
PHONE ______
ADDRESS ______
CITY, STATE, ZIP ______
E-MAIL ______
Member of ACB of Oregon: YES ___ Chapter Name: ______NO ______
Are you a student: YES ______NO ______
Do you wish to have a Student Stipend: YES ______NO ______
Do you need an assistive listening device: YES ______NO ______
Program Format Preference Large Print ______Braille ______
Registration allows all members paid and certified on ACB membership list to attend the convention Friday, Saturday, and/or Sunday morning to vote. It also covers meals as stated on page two.
In order to have packets with name badges, program agenda and meal selections ready please return this completed form, then stop by the convention registration desk upon arrival to pick up your Convention Packet.
If you wish to attend the convention but with no meals included or a single meal, please contact Susan Schwab at or (503) 871-6175.
Red Lion Hotel says no outside food may be brought into meeting rooms.
MEAL INFORMATION
.
$50 Registration fee for members includes all meals.
Friday Night Dinner will be on your own, then join us for Karaoke and Social time.
Willamette Chapter will provide a no host bar.
Saturday Lunch (Please mark one meal choice)
1._____Turkey Croissant Sandwich – Oven Roasted Turkey, Bacon, Lettuce, Tomato, Swiss Cheese, with Pasta Salad
2._____The Vegetarian – Balsamic grilled Portabella Mushroom, Roasted Red Peppers, Lettuce, Spicy Hummus on Ciabatta bread, with Fruit Salad
Saturday Banquet Dinner (Please mark one meal choice)
1._____Apple Cider Boneless Pork Chop - Braised greens, Pancetta and Goat Cheese Polenta, with salad and fresh seasonal vegetables
2._____Citrus Crusted Halibut – Curried Sweet-Potato Puree and Mango Relish, with salad and fresh seasonal vegetables
3._____Spinach Crepes with Wild Mushrooms – Roasted Pepper Coulis, with salad and fresh seasonal vegetables
For special diet restrictions, please contact Susan Schwab (contact information at the end of this form) by the September 24, 2016 deadline.
If you are attending only one day of the Convention, meals can be purchased on an individual basis. The prices below are for individual meals only. Do not make a selection here if you marked your meal choices above.
Saturday lunch:
1._____ Turkey Croissant Sandwich $18.00
2._____ The Vegetarian $19.00
Saturday banquet dinner
1._____ Apple Cider Boneless Pork Chop $30.00
2._____ Citrus Crusted Halibut $30.00
3._____ Spinach Crepes with Wild Mushrooms $29.00
CONVENTION HOTEL INFORMATION
Red Lion Hotel & Convention Center
3301 Market St. NE
Salem, Oregon 97301
Phone: (503) 370-7888
Mention you are with the American Council of the Blind of Oregon to receive the room rates. After September 24, 2016, room rates will change.
Room Rates: $89.00 per night plus tax Standard Room
· Complimentary breakfast is included with room reservation.
· There is a $15 pet fee for non-service animals. To help maintain allergy-free rooms the hotel is placing guests with pets (including service animals) on the second floor.
· Please confirm the check-in time and check-out time.
** Hotel Reservation Deadline: September 24, 2016 **
MAILING INFORMATION:
REGISTRATION FEE $50; Late Registration, $75):
Make Checks Payable to : ACB of Oregon
This registration form can be submitted two ways:
(1) Email completed registration forms to Sue Schwab at: , then mail checks to address below.
- OR –
(2) Mail registration and checks payable to:
ACB of Oregon
4352 Trapper Dr. NE
Salem, OR 97305
______
Any questions about registration, contact Sue by email, mail or phone.
Email: Phone: 503-871-6175 Fax: 503-689-1588