NABS At Large Seminar Registration Form
Welcome to the registration form for the NABS At Large Seminar: “Speaking Up and Branching Out”, taking place January 9 - 10 2021.This virtual program, designed to empower blind students to sharpen their public speaking skills, hopes to equip attendees with techniques and the self-confidence to advocate effectively in academic and everyday life. With guest speakers, philosophical discussions, and interactive activities, your participation in this event is both a resource for professional development and interpersonal networking.
The deadline for completion of this form and payment of the $25 registration fee is Tuesday, December 15, 2020 at 11:59pm EDT. Please direct all registration questions to Kinshuk Tella at kinshuk.tella@gmail.com and see the confirmation message after submitting this form for methods of payment.

Please complete the following questions before submitting the form. Required questions are denoted with an asterisk.
Email address *
Your Full Name *
Your Preferred Name
Your Pronouns
Your Phone Number? *
What is your Home State?
What is your School State?
Please Select Your Educational Status:
Clear selection
What is the name of your educational institution?
What is your career goal?
Are You a Member of NABS? *
What mobility tool do you use? Check all that apply. *
Required
Which assistive technology do you use? Check all that apply
What is your preferred format type? *
How Did You Find Out About This Seminar? *
What Areas of public speaking Do You Wish to Learn from and Improve upon the Most? *
How would you describe your public speaking Experience? *
As part of the seminar, we plan to offer an opportunity for mentorship. In an effort to ensure that mentors are represent the diversity within NABS, please share any characteristics you would value in your mentor.
What method do you intend on using for paying your $25 registration fee?
Clear selection
By checking this box, I certify that I give the National Federation of the Blind and it’s presenting division, the National Association of Blind Students, permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the NABS At Large Seminar or activities. I agree that the National Federation of the Blind and NABS has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the NFB/NABS mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc., and hereby release the NFB, NABS, their agents and assignees from any and all claims which arise out of or are in any way connected with such use. *
By checking this box, I certify that I have read and understand the expectations of the National Federation of the Blind’s Code of Conduct. I affirm that I will, throughout the duration of my attendance of the national seminar, conduct myself with the outlined principles of the code, facilitating positive interaction with my fellow attendees. I also affirm that I have visited our national organization’s webpage and have reviewed the Code of Conduct, which can be found at https://www.nfb.org/about-us/history-and-governance/code-conduct. *
If you are under the age of 18, please have your parent or legal guardian sign this registration form and provide their information below
Parents’ Signature (If Student is Under the Age of 18), Parent’s Contact Phone Number, Parent’s E-Mail Address:
Attendee/Student Signature (If Over the Age of 18)
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