Braille Monitor                                                                                 March 2006


2006 National Convention Preregistration Form

Please use this form or provide all the requested information.

Registrant Name ___________________________________________________
(print legibly)
Address _________________________________________________________
City ____________________________________________________________
State ___________________________________ Zip ____________________
Phone __________________________________________________________

___ I will pick up my registration packet at convention.
___ The following person will pick up my registration packet: Pickup Name ______________________________________

Please register only one person per registration form.
One check or money order may cover multiple registrations.
Check or money order (sorry, no credit cards) must be enclosed with registration form(s).

Number of registrations x $15 = ____________

Banquet tickets x $35 = ____________

Total ______________

Mail to: National Federation of the Blind
Attn: Convention Registration
1800 Johnson Street
Baltimore, MD 21230

Registrations must be postmarked by May 31, 2006.