CICBVI Presents 2nd Annual Dinner in the Dark -- Participant Registration
Date: Sunday, October 13th, 2019
Time: 5:30 p.m.
Location: The Warehouse on State (736 SW Washington, Peoria, IL)
Price: $100/ticket
Would you like to sponsor this event instead? Click the link below:
Registration Information:
Email Address: *
Your answer
Name: (Last, First) *
Your answer
Street Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Phone Number: *
Your answer
Meal Choice: *
Please list any dietary restrictions below (e.g. gluten-free, nut-free): *
Your answer
Comments:
Your answer
Payment Method: *
Please make check payable to "CICBVI" and send to:
Central Illinois Center for the Blind and Visually Impaired (CICBVI)
2905 W Garden St
Peoria, IL 61605

*Once payment is received, a receipt will be emailed to you or a printed receipt will be given to you the night of the event.

Paying using our PayPal account? Here's how:
*An online service fee of 3.00% will be added to your registration fee.
*A receipt will be emailed to you

1. Click this link: www.cicbvi.org/2019-dinner-in-the-dark-attendee-online-payment
2. Select the number of tickets you would like to purchase from the drop down menu.
3. "Add to Cart" and pay using PayPal or your credit/debit card.

Questions?
Contact Felisa Durr
309-637-3693
info@cicbvi.org

OR

Darlene Violet
309-240-8597
groovym2@aol.com

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service