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IOWA COUNCIL OF THE UNITED BLIND (ICUB)

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Event Sign-Up Form

2024 ICUB Convention and Conference

Before filling out the sign-up form below, you can review the event details by downloading the Event Packet using the buttons below. The first button is for the Microsoft Word version, the second is for the PDF version.

Download Event Info Word Document

Download Event Info PDF

Once you have read the Event Packet, fill out the form below to sign up. Registration is $20. Meals are extra and denoted below:

2024 Convention Sign Up Form

Enter your contact information and make your meal selections below. Each registrant must fill out the form separately:

Enter Your First Name

Enter Your Last Name

Enter Your Email Address

Enter Your Phone Number

Street Address

City

State

Zip Code

WILL YOU BE ATTENDING IN PERSON OR OVER ZOOM? *

I will be attending in person.

I will be attending over Zoom.

SELECT THE BREAK-OUT SESSIONS YOU'D LIKE TO ATTEND

“Technology Timeline”

“Touch and Go” with the Des Moines Historical Society

SELECT BREAKFAST OPTION ($18)

The Heartland – scrambled eggs and breakfast potatoes with sausage. Served with a fruit cup and choice of juice, tea, or milk.

Bistro Breakfast Sandwich – scrambled eggs, Applewood-smoked bacon, and white cheddar cheese on a brioche roll. Served with a fruit cup and choice of juice, tea, or milk.

Healthy Start Breakfast – egg whites, turkey, spinach and Havarti on an English muffin. Served with a fruit cup and choice of juice, tea, or milk.

SELECT LUNCH OPTION ($22)

Gourmet Cheeseburger – 1/4 pound hamburger with smoked bacon, white cheddar cheese, lettuce and tomato on a Brioche bun. Served with pickle chips, seashore-style fries, fruit cup and choice of water, lemonade, or tea.

Croissant Sandwich – Croissant stuffed with ham, turkey, Swiss and cheddar cheese, topped with bacon, lettuce and tomato. Served with chips, fruit cup and choice of water, lemonade, or tea.

Southwest Chicken Salad – Grilled chicken on top a bed of romaine lettuce, black beans, corn shredded cheddar cheese, tortilla strips and creamy chipotle dressing on the side. A choice of water, lemonade, or tea.

Veggie Wrap – Vegetable wrap served with a fruit cup, pasta salad and choice of water, lemonade, or tea.

SELECT BANQUET OPTION ($40)

Rosemary Pork Loin – Tender roasted pork loin dressed with a creamy rosemary sauce. Served with roasted Yukon potatoes, salad, fresh vegetables, specialty bread, and choice of water, iced tea, lemonade, or coffee.

Bacon wrapped Sirloin – 8 oz. sirloin wrapped with Applewood-smoked bacon topped with a demi-glaze sauce. Served with garlic mashed potatoes, salad, fresh vegetables, specialty bread and choice of water, iced tea, lemonade, or coffee.

Grilled Bruschetta Chicken – herb seared chicken breast topped with roasted cherry tomatoes, onion, basil and fresh garlic in wine sauce. Served with baked potato casserole, salad, fresh vegetables, specialty bread, and choice of water, iced tea, lemonade, or coffee.

Ricotta Stuffed Tortellini – Tortellini pasta stuffed with Ricotta cheese and topped with a creamy Alfredo sauce. Served with salad, fresh vegetables, specialty bread, and choice of water, iced tea, lemonade, or coffee.

ADDITIONAL DONATION AMOUNT (OPTIONAL)

PAY ELECTRONICALLY OR BY CHECK *

I would like to pay electronically.

I would like to pay by check.

When you submit this form with the button below, you will receive a confirmation email. After that, if you elected electronic payment, you will receive another email with a link to make your payment. If you elected to pay by check, please send it to Jeana Mowery, Treasurer, 29965 185th St. Honey Creek, IA 51542. Make checks payable to the Iowa Council of the United Blind. Thank you!

Thank you for registering! You will receive an email confirmation shortly. If you do not see it within 15 minutes, please check your spam folder. Thank you! See you at the event!

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© 2024 Iowa Council of the United Blind

An Affiliate of the American Council of the Blind (ACB)

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Thank you to the Greater Iowa Credit Union (GICU) for providing financial support for this website.

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