Events

April 13-15, 2018 Theme- 1970’s-Night at the Disco Registration  Form  

KY Deaf-Blind Retreat-KADB Members & Deafblind Attendees

Name: ___________________________________________________________________

 

Address: __________________________________________________________________

 

City: ____________________________________   State: _____________ Zip: ___________

 

Phone/Text/VP: ____________________________________________________________

 

Email: ____________________________________________________________________

 

Accommodation Information

 

Health or Special Diet Needs: Yes _____ No ______

 

Specify: ___________________________________________________________________________________

 

Interpreter Requested: Yes _______ No _________                   Circle which: ASL     or     Signed English

 

Human Guide/SSP Requested: Yes _________ No _________

 

Assistive Listening Device Requested: Yes _________ No _________

 

Other (please specify): _______________________________________________________________________

 

Circle the Night(s) You Plan To Attend & Rooming Preference

Friday, April 13, 2018

Saturday, April 14, 2018

Sunday, April 15, 2018

 

Roommate(s) Preference: ________________________________________________________

 

Need transportation: __________ Yes ___________ No

Providing own transportation ________ Yes ___________ No

 

Please try to provide own transportation if possible!

We cannot guarantee transportation availability this year!

Please return by 3/17/2018 to:

Chad Hunt (Chad.Hunt@nullky.gov)

955 Fairview Avenue, Suite 100

Bowling Green, KY 42101

270 746-7479

270 746-7481 FAX

If you would like your event mentioned here, please send information to: Brenda.Mullins@nulluky.edu.