Attendee Registration Form 2015

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone *

E-mail Address: *

I am a member of ACBNY

Program Format Choice *

Braille
E-Mail
Large Print

Convention Registration *

Single Day Individual Pass Friday October 30, 2015 $10
Single Day Individual Pass Saturday October 31, 2015 $10
Single Day Family Pass Saturday October 31, 2015 $15
Full Convention Registration $25

Will you be staying at the hotel? $119 per night

Wednesday October 28, 2015 $119
Thursday October 29, 2015 $119
Friday October 30, 2015 $119
Saturday October 31, 2015 $119

Name of Roommate(s)

I will attend the Accessible pedestrian Signal Workshop on Thursday morning from 9:15 to 10:30am?

PreConvention Leadership Training

Smoked Turkey Panini
Roasted Vegetable Baguette

I will attend ShowBoat the Musical with audio description at the Westchester Broadway Dinner Theatre for $97 which includes transportation

I will need a receiver for audio description ofShowBoat the Musical

I will attend the New York State Commission Town Hall Meeting on Friday Morning 10am to 12pm

Winetasting Friday evening 8pm $25 per person ID Required

Continental Breakfast $21 per person per day

Friday October 30, 2015 $21
Saturday October 31, 2015 $21
November 1, 2015 $21

Friday Luncheon $28 per person

Mesculn Salad with Grilled Chicken Breast, Cucumbers, Tomatoes $28
Half Roast Beef Wrap & Half Thai Chicken Wrap served with Tri Colored Farfalle with Asparagus, Leeks and Peppers $28
Mesculn Greens Salad with Cucumbers, Tomatoes, Crotons $28

Saturday Luncheon $38 per person

Chicken Marsala with Yellow Rice and Medley of Seasonal Vegetables $38
Penne Pasta with Asparagus, Sherry Butter $38

Saturday Evening Banquet $55 per person

Chicken Breast with Vidalia Onion, Balsamic Reduction served with Oven Roasted Potatoes and Broccoli and Carrots $55
Pork Medallion with Pineapple Mango Salsa with Oven Roasted Potatoes and Broccoli and Carrots $55
Eggplant Rollatini $55

I will attend the CCLVI workshop on Saturday afternoon? 2:30 to 4pm

I will attend the Guide Dog Users Workshop on Saturday afternoon? 2:30 to 4pm

I would like to place a program ad

Full Page Ad $250
Half Page Ad $150
Quarter Page Ad $100
Business Card Ad $50

Individual Sponsorship

Platinum Sponsorship $250
Gold Sponsorship $100
Silver Sponsorship $50
Bronze Sponsorship $25

Reasonable Accommodations (Please describe)

Method of Payment *

Mailed Regular Check
PayPal

Total amount to be paid

Checks can be mailed to:
ACBNY 2015 convention
c/o Michael Golfo
1403 Chadwick Court, Tarrytown, N.Y. 10591

* Required