American Councilofthe Blindof Oregon

63rd Annual ConventionOctober20-22, 2017

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 28, 2017

Please complete entire registration packet

NAME______

PHONE______

ADDRESS______

CITY, STATE, ZIP______

E-MAIL______

Memberof 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 PreferenceLarge 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 conventionbut with no meals included or a single meal, please contact Susan Schwab at or (503) 871-6175.

The Mill Casino & Hotel says no outside food may be brought into meeting rooms.

SATURDAY AFTERNOON ACTIVITIES

In order to accommodate transportation needs and adequate meeting space we need to know your preference of activities.

Please select 2 activities that you would like to attend:

_____ Oregon Institute of Marine BiologyHands-On Tour

includes Bus Transportation to Facility

_____ Amazon Echo Workshop on Adaptive Uses

_____ Casey Eye Institute Focus Group with Tasha Zabach

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.

Southwestern Chapter will provide Hors d’oeuvres and No Host Bar.

Saturday Lunch (Please mark one meal choice)

1.____The Executive Lunch – Roast Beef, Ham, Jalapeno Jack Cheese on Croissant, Orzo Pasta Salad with Feta Cheese & Sweet Peppers, Fruit Garnish

2.____Grilled Vegetable Sandwich – Marinated & Grilled Portabella Mushroom, Zucchini, Yellow Squash, Roasted Red Pepper & Mozzarella on Focaccia Bread

Saturday Banquet Dinner (Please mark one meal choice)

1.____Chicken Fettuccini Alfredo – Sundried Tomato & Goat Cheese stuffed Chicken Breast on Fettuccini Alfredo, Asparagus and Baby Carrots

2.____Cedar Plank Salmon – Cedar Plank Salmon with Huckleberry Glaze, Hazelnut Rice Pilaf, Asparagus with Grilled Corn Relish

3.____Penne Pasta – Penne Pasta Sautéed with Wild Mushrooms, Squash, Peppers, and Garlic Tossed in a Tomato Basil Sauce

For special diet restrictions, please contact Susan Schwab(contact information at the end of this form) by the September 30, 2017 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: Saturday banquet dinner:

1.____The Executive Lunch $18.00 1.____Chicken Fettuccini Alfredo $28.00

2.___ Grilled Vegetable Sandwich $15.00 2.____Cedar Plank Salmon $35.00

3.____Penne Pasta $25.00

CONVENTION HOTEL INFORMATION

The Mill Casino – Hotel & RV Park

3201 Tremont Avenue

North Bend, Oregon 97459

Phone: (541) 756-8800

Mention you are with the American Council of the Blind of Oregon to receive the discounted room rates.

** Hotel Reservation Deadline: September 28, 2017 **

  • Room Rates: $95.00 per night plus tax Standard Room
  • After September 28, 2017, room rates will change.
  • Please confirm the check-in time and check-out time.

MAILING INFORMATION:

REGISTRATION FEE $50; Late Registration, $75):

Make Checks Payable to : ACB of Oregon

This registration form can be submitted two ways:

(1)Emailcompleted registration forms (Pages 1-3) to Sue Schwab at: , then mail checks to address below.

- OR –

(2)Mail registration and checkspayable to:

ACB of Oregon - Treasurer

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

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