First Name *

Last Name *

Position * Please indicate all that apply

Orientation and Mobility Instructor
Dog Guide Trainer
Student / O&M Instructor in Training
Teacher of the Blind and Visually Impaired
Parent of a consumer
Traffic engineer
Administrator
Related Service Provider
Other

Phone * include area code

Email *

Agency or School Division (if applicable)

The address provided below is my *

Work address
Home address

Street address or PO box *

City *

State *

Zip *

BLINDFOLD WALK ADVENTURES TO RESTAURANT

We are offering blindfold walks to restaurants on Saturday and Monday evenings (they have been approved by ACVREP credit). Please check the boxes below if you think you'd like to bring your blindfold and cane and participate in one or both of these. Thanks!

I want to join blindfold walk:

Saturday 9/29 6:00-7:00 PM
Monday 10/1 6:00-7:00 PM
Undecided

SPECIAL ACCOMMODATIONS:

Pleae list any special accommodations or assistance you need in order to participate in this conference.

Payment Information

Registration Fees *
The deadline for Early Registration was September 4, 2012

Payment by Check or Paypal *

If paying by check:

If paying by Paypal

SOMA-COMA 2012 REGISTRATION

Payment Information

Cancellation Policy