2021 Georgia State Convention Registration – The National Federation of the Blind of Georgia

Registration Fee: $20 per person 18 yrs and older. One registration form per person. Peach PAC Plan Donation $5. All Sales Are Final.

How Would You Like To Pay? *OnlineCheckYou can pay by check or online

First Name *

Last Name *

Email Address

Home Phone

Cell Phone

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Registration Only $(20)Georgia Peach PAC Plan $(5)

Which Chapter Are You A Member? *

NoneDiabetes Action NetworkGeorgia Assoication of Blind StudentsSeniors

Would You Like Info On A Chapter In Your Area?

What Is Your Vision Status?

StudentParent Of A Blind ChildBlindness Professional

Total Payment Amount

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