ACBNY 2024 Legislative Registration - Check

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
If you are a hotel guest, are you traveling with a guide dog?

If you are a hotel guest, are you traveling with a guide dog? Yes No
Are you affiliated with:

Are you affiliated with: ACBNY NYVRA Other
If ACBNY, what is your primary chapter/affiliate?
Will you need a hotel room? Room rate is $114 per night. Mark each night you will be staying below:

Will you need a hotel room? Room rate is $114 per night. Mark each night you will be staying below: May 18th May 19th
Would you like a room with one bed, or two beds?

Would you like a room with one bed, or two beds? One Bed Two Beds
Please indicate which meals you would like to purchase, and how many:
Breakfast on May 19th

Breakfast on May 19th $37.00 each (Plated breakfast)
Number of Breakfasts (5/19)
Maximum of 2 digits allowed. Currently Entered: 0 digits.
Breakfast on May 20th

Breakfast on May 20th $37.00 each (Plated breakfast)
Number of Breakfasts (5/20)
Maximum of 2 digits allowed. Currently Entered: 0 digits.
Please mail checks to:
Rosanna Beaudrie
8 Hemlock Lane
Levittown, New York 11756
$0

Total