2024 NFB of Iowa State Convention Registration Form | National Federation of the Blind of Iowa

This registration form must be submitted by or before 11:59 PM on September 30th, 2024. All convention attendees who pre-register will benefit from a lower registration fee and an opportunity to purchase food at greatly reduced prices.

Please note that all on site registrations, and any completed after September 30, will incur an additional charge of $5 per item and you might not be able to purchase meals depending on availability.

You must register to be eligible to win a door prize. Registration is due by September 30. To vote during any part of the convention, you must be registered and a current dues paying member of the National Federation of the Blind of Iowa.

If you are registering multiple people for the convention, you MUST fill out a separate form for each attendee.

Please note that using the arrow keys will greatly improve your ability to view all of the information on this form when navigating with a screen reader. Upon completing this form, please review your entries on the next screen to confirm everything is correct before your registration is considered as submitted.

Convention Registration

First Name *

Last Name *

Street Address *

Supplemental Address 1

City *

State *

Postal Code *

Country *

PHONE #: (Used for contact) *

Email Address *

Preferred Agenda Type *

Braille Large Print Electronic

Are you a current dues paying member of a Chapter/Division of the National Federation of the Blind of Iowa? *

Yes No

This means paying dues during the current calendar year for at least one of the NFBI chapters or divisions. This is not the same as being a member of our tall-corn mailing list.

Are you blind or low vision? *

Yes No

Are you the parent of a blind/low vision child? *

Yes No

Are you a blindness professional? *

Yes No

Would you like us to add your email to our tall-corn mailing list automatically? *

Yes No

Are you a student? *

Yes No

Are you a blind parent? *

Yes No

Are you a guide dog user? *

Yes No

What chapter do you belong to? *

Please select your age bracket *

Under 18 18-30 31-50 51-65 66+

Breakout Sessions:

Saturday afternoon we will be holding two sets of breakout sessions, one from 2:00-3:15 and the second from 3:30-4:45. we want to plan the timing of which sessions we offer when so that as many people as possible can attend both their first and second choices. Please mark the top two sessions you would like to attend from the list.

First Preference *

Second Preference *

General Release of Liability and Hold Harmless Agreement:

By checking the checkbox below, I agree to assume all risks and to release, hold harmless, and covenant not to sue the National Federation of the Blind or any designated beneficiaries, sponsors, officers, officials, affiliates, chapters, communities, organizations, friends of the event, and all other government or public entities and all their respective directors, officers, agents, employees, and members for any claim, loss, or liability that I may have arising out of my participation in the event. I / My child will participate in the event facilitated by the National Federation of the Blind of Iowa. I / My child will adhere to any and all rules and policies of the Program. I agree / My child has permission to participate in all activities of the Program.

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I accept

Media Release Form

By checking the checkbox below, I hereby give permission to photograph me (and my child) and to use audio and/or video equipment to record my participation in the National Federation of the Blind of Iowa (NFBI) event. I grant permission to use said photos or recordings to promote the programs of the National Federation of the Blind (NFB) and the National Federation of the Blind of Iowa. I also understand that print and visual media may be used to distribute information regarding my and/or my child(ren)’s participation in the program. It is understood that this material will be used solely for educational purposes or to promote the programs of the NFB and NFBI.

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I accept

Code of Conduct Agreement

By checking the checkbox below, I acknowledge that I have read the Code of Conduct of the National Federation of the Blind and that I agree to follow its policies, standards, and principles during this National Federation of the Blind sponsored event. This policy will be enforced during the event.

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I accept

Breakout Sessions:

General Release of Liability and Hold Harmless Agreement:

Media Release Form

Code of Conduct Agreement

Registration Fees & Checkout:

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