NATIONAL FEDERATION OF THE BLIND OF CT REQUEST FOR GRANT/TRAVEL EXPENSE NATIONAL CONVENTION OR WASHINGTON SEMINAR

I am applying for a subsidy for *

I am applying for a grant

I am applying for a travel expense

National Convention

Washington Seminar

First Name *

Last Name *

Street Address *

Address Line 2

City *

State/Providence *

Zip Code *

Phone Number *

Email Address

If I am accepted, I will turn in my receipts, totaling over the amount the affiliate has awarded for that year (airfare, hotel, etc), within 30 days of returning.

Receipt Submission Agreement *

I accept

I agree to abide by the rules that are found at www.nfbct.org/subsidy-guidelines-and-procedures. I also have read and agree to the National Federation of the Blind's Code of Conduct.

Guidelines Compliance Agreement *

I accept

Signature *

Signature Date *

Month

Day

Year

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