Family and Friend's Day, 2022 Reg

VRCBVI's Family and Friend's Day, 2022

Register here! (screen reader users, please use the up and down arrows to navigate this form)

Contact Person Info (Participant 1)

Who is the contact person for your party (Participant 1)?

Participant 1 email address (Please double check for accuracy, this is where all program information will be sent):

Participant 1 phone number:

Participant 1 is a: I am a

Participant 1 is a: DBVI client in the Vocational Rehabilitation Program DBVI client in the Rehabilitation Teaching Program VRCBVI student Former VRCBVI student Student (14 to 21 years old) Family member TVI DBVI Staff Other

If you listed "other" for Participant 1 above, please explain below:

How many people (including yourself) will be in your party? Parties are limited to 5 or less.

Participant 2 Info (if needed)

Participant 2 name:

Participant 2 is a:

Participant 2 is a: DBVI client in the Vocational Rehabilitation Program DBVI client in the Rehabilitation Teaching Program VRCBVI student Former VRCBVI student Student (14 to 22 years old) Family member TVI DBVI Staff Other

If you listed "other" for Participant 2 above, please explain below:

Participant 3 Info (if needed)

Participant 3 name:

Participant 3 is a:

Participant 3 is a: DBVI client in the Vocational Rehabilitation Program DBVI client in the Rehabilitation Teaching Program VRCBVI student Former VRCBVI student Student (14 to 22 years old) Family member TVI DBVI Staff Other

If you listed "other" for Participant 3 above, please explain below:

Participant 4 Info (if needed)

Participant 4 name:

Participant 4 is a:

Participant 4 is a: DBVI client in the Vocational Rehabilitation Program DBVI client in the Rehabilitation Teaching Program VRCBVI student Former VRCBVI student Student (14 to 22 years old) Family member TVI DBVI Staff Other

If you listed "other" for Participant 4 above, please explain below:

Participant 5 Info (if needed)

Participant 5 name:

Participant 5 is a:

Participant 5 is a: DBVI client in the Vocational Rehabilitation Program DBVI client in the Rehabilitation Teaching Program VRCBVI student Former VRCBVI student Student (14 to 22 years old) Family member TVI DBVI Staff Other

If you listed "other" for Participant 5 above, please explain below:

NOTE: If your submission was received, you will see a blue, “Thank you Your form has been submitted" screen and a confirmation email. If you do not receive both of these please resubmit and double check the email you provided under Participant 1 in the above link.