White Cane Day 2019
Registration Form for the 7th Annual White Cane Day for the state of Alabama, hosted by Alabama Institute for Deaf and Blind(AIDB) and Alabama Department of Rehabilitation Services(ADRS)

Please complete this form for all members of your family and or group that may be coming.
Email Address *
Your answer
Last Name *
Your answer
First Name *
Your answer
Phone *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Zip *
Your answer
Are you 19 years or older *
Alabama White Cane Day 2019 Logo
PD: A vine covered water pump with a white cane behind it and the words Tuscumbia Alabama in black letters above the cane, Around the side in white and black lettering is the words White Cane Day Shoals 2019 in a circle above that 7th Annual in red and black. With a light blue background
Never submit passwords through Google Forms.
This form was created inside of Alabama Institute for Deaf and Blind.