2025 ACB-N State Convention Registration

Contact Information

Full Name *

Street Address *

Apartment, suite, etc

City/State *

ZIP / Postal Code

Primary Phone *

Text

Email Address *

Re-type Email Address *

Carefully choose option that applies: *Both March 21 & 22 ACBN Member After Feb. 28 will be $120Both March 21 & 22 Non ACBN Member After Feb 28 will be $140Both March 21 & 22 ZOOM only $40March 21 ONLY AI Workshop ACBN Member After Feb 28 will be $60March 21 ONLY AI Workshop Non ACBN Member After Feb 28 will be $70March 21 ONLY AI Workshop ZOOM only $25March 22 ONLY Convention ACBN Member After February 28 will be $75March 22 ONLY Convention Non ACBN Member After Feb 28 will be $85March 22 ONLY Convention – ZOOM only $25

Meals: Select March 21 meal choice

March 21 Meal choices:FishBeef Stroganoff

Gluten-free?Check this box if you want gluten-free.

Allergies?Check this box if you have allergies.

Meals: Select March 22 meal choices

March 22 Lunch choice:Ham sandwichTurkey sandwichPeanut Butter & Jelly sandwich

Gluten-free?Check this box if you want gluten-free.

Allergies?Check this box if you have allergies.

March 22 Dinner choice:BrisketSmothered Chicken BreastBaked Pasta

Gluten-free?Check this box if you want gluten-free.

Allergies?Check this box if you have allergies.

Format of convention materials

Format of convention materials: *EmailLarge printBraille

Sponsorship Opportunity: You will be listed as a sponsor in our program

PAYMENT

Choose Payment Method *I will submit my payment online on the page that appears after submitting this form.I will submit my payment over the phone at 402-679-8448.

Cancellation policy *I understand that cancellations received March 17 or later are non-refundable.