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Request for Subsidy - National Convention or Washington Seminar
December 31, 2020 - 6:26pm —
Brian Mackey
I am applying for a subsidy for
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National Convention
Washington Seminar
First Name
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Last Name
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Street Address
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Address Line 2
City
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State/Providence
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Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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Phone Number
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Email Address
I am involved with the NFB of CT by one or more of the following
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Chapter Meetings
Member-At-Large
Outreach Tables
CT Association of Blind Students
CT Association of Guide Dog Users
NOPBC
Other (Donor, Volunteer, etc.)
I am involved with the NFB of CT by one or more of the following Other (Donor, Volunteer, etc.)
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
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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
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I accept
Signature
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Signature Date
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Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2021
2022
2023
2024
2025
Math question
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5 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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