Convention Registration

National Federation of the Blind of Missouri

2023 State Convention Online Registration Form

St. Louis, MO April 13 - April 16 , 2023

For the full convention experience, we recommend ordering the Frugal Federationist Package and adding a Friday lunch and a prayer breakfast ticket.

Sorry no refunds unless the event is canceled.

Whose name should your purchase be placed under? This is the name that your convention packet will be placed under.

Convention Packet Name *

The Frugal Federationist Package includes convention registration, a banquet ticket and a Saturday lunch ticket, saving you up to $30.

Will you be registering with the Frugal Federationist Package or Standard Adult Registration *

Including yourself how many Frugal Federationist Packages would you like?

Frugal Federationist Package [$70.00]

Including yourself how many ADULTS will you be registering?

Convention Registration(s) ADULT [$25.00]

How many CHILDREN (ages 12 and under) will you be registering?

Convention Registration(s) CHILD [$10.00]

Do you wish to purchase planned ADULT meals? *

Do you wish to purchase planned CHILD meals? (ages 12 and under) *

1st. ADULT registrant

First Name *

Last Name *

Cell Phone

(

Area code

)

Prefix

Number

E-Mail Address

Prefered Agenda Format *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Home Phone

(

Area code

)

Prefix

Number

2nd. ADULT registrant

First Name *

Last Name *

Cell Phone

(

Area code

)

Prefix

Number

E-Mail Address

Prefered Agenda Format *

Does this person live at the same residence as the first registrant? *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Home Phone

(

Area code

)

Prefix

Number

3rd. ADULT registrant

First Name *

Last Name *

Cell Phone

(

Area code

)

Prefix

Number

E-Mail Address

Prefered Agenda Format *

Does this person live at the same residence as the first registrant? *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Home Phone

(

Area code

)

Prefix

Number

4th. ADULT registrant

First Name *

Last Name *

Cell Phone

(

Area code

)

Prefix

Number

E-Mail Address

Prefered Agenda Format *

Does this person live at the same residence as the first registrant? *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Home Phone

(

Area code

)

Prefix

Number

1st. CHILD registrant

First Name *

Last Name *

Age of child * years

Are you requesting supervised care for this child? *

Special Concerns

2nd. CHILD registrant

First Name *

Last Name *

Age of child * years

Are you requesting supervised care for this child? *

Special Concerns

3rd. CHILD registrant

First Name *

Last Name *

Age of child * years

Are you requesting supervised care for this child? *

Special Concerns

4th. CHILD registrant

First Name *

Last Name *

Age of child * years

Are you requesting supervised care for this child? *

Special Concerns

ADULT Meal Tickets

NOTE - Each Frugal Federationist Package comes with a banquet and a Saturday lunch ticket. If you registered with the Frugal Federationist Package there would be no need to add those meals here unless you would like to order additional meals.

How many Annual Banquet tickets would you like?

Annual Banquet ADULT Ticket(s) [$40.00]

How many Friday Luncheon tickets would you like?

Friday Luncheon ADULT Ticket(s) [$20.00]

How many Saturday Luncheon tickets would you like?

Saturday Luncheon ADULT Ticket(s) [$20.00]

How many Prayer Breakfast tickets would you like?

Prayer Breakfast ADULT Ticket(s) [$15.00]

CHILD Meal Tickets

How many Annual Banquet tickets would you like?

Annual Banquet CHILD Ticket(s) [$20.00]

How many Friday Luncheon tickets would you like?

Friday Luncheon CHILD Ticket(s) [$10.00]

How many Saturday Luncheon tickets would you like?

Saturday Luncheon CHILD Ticket(s) [$10.00]

How many Prayer Breakfast tickets would you like?

Prayer Breakfast CHILD Ticket(s) [$10.00]

In order to assist the NFB of Missouri in its mission to help all blind people live the life that they want, I would like to make an additional *