[IABS-Talk] at large convention assistance

[David Meyer]

National Federation of the Blind of Illinois
At Large Chapter

Application for assistance in attending National Convention

The National Federation of the Blind of Illinois believes it is 
important for those who may not have had much personal contact with 
other Federationists to attend the NFB National Convention. Those of us 
who have attended conventions believe that the experience changes the 
lives of attendees, allowing us to interact with blind people who are 
living the lives they want and work around the obstacles blindness is 
thought to impose. Unfortunately, the expenses of traveling to and from 
a national convention and the associated food and lodging expenses of 
attending preclude many from participating in the experience, an 
experience only partially available over Zoom. The At Large Chapter set 
out to assist possible attendees by conducting a popcorn fund raiser, 
which was generously supported by members and others. This application 
allows us to select a person or persons to whom we will provide 
assistance to those whose limited resources would otherwise make 
convention attendance impossible. Potential Recipients must also 
demonstrate genuine interest in, and commitment to the blind of 
Illinois or the potential to develop such interest and commitment.  
Recipients are expected to attend all sessions relative to the convention.

        The attached application must be completely filled out and 
emailed to NFBI At Large President Dave Meyer. Please submit this form 
in an accessible format, .doc, .docx, .txt, .rtf or an accessible Adobe 
PDF. The form may be attached to a message and emailed to datemeyer at mysero.net.

Assistance to NFBI National Convention Application

APPLICANT:
Name                                    Date

Phone:
Cell:
e-mail:

Check (X) each item for which assistance is sought. Indicate the 
assistance you need and estimate the amount needed.
( ) Transportation:             $______
( ) Lodging:                    $ covers ___ # of nights.
Note: award of $65 per night assumes double occupancy. Single occupants 
are responsible for the difference.

( ) Meals: $                            ______
( )  Registration:              $25
( ) Banquet:                    $70


( ) other: ____________________________________________
I expect my costs for the above to be approximately:  $____

NFBI reserves the right to reduce or eliminate any award based on a 
change of plans by the applicant.  For example, if you indicate that 
you will stay 5 nights and change your plans to stay less time, (absent 
an emergency) the NFBI At Large Chapter may require repayment of all or 
a portion of the award.

Please indicate your estimated yearly income.
Indicate any other sources for funding you have applied to, including 
the NFB Jernigan Award, other NFBI Chapters, etc:

Indicate Federation activities in which you have been involved, 
including but not limited to conventions, seminars, fund raising, 
legislative action, and chapter membership :



Signature of Applicant:  (You may sign electronically)




RELEASE FROM ALL LIABILITY AND CONSENT FORM
National Federation of the Blind of Illinois


If the applicant is under age 18 at the time of the event, a parent or 
guardian must sign a release.  This ensures that all under aged 
applicants have parental permission to attend the event and submit this 
application.

By signing my name below, I agree to assume all risks and to release, 
hold harmless, and covenant not to sue the National Federation of the 
Blind or any designated beneficiaries, sponsors, officers, officials, 
affiliates, chapters, communities, organizations, friends of the event, 
and all other government or public entities and all their respective 
directors, officers, agents, employees, and members for any claim, 
loss, or liability that I may have arising out of my participation in 
the event.

I / My child will participate in the event facilitated by the National 
Federation of the Blind of Illinois.  I / My child will adhere to any 
and all rules and policies of the Program.  I agree / My child has 
permission to participate in all activities of the Program.

________________________________________
Name of Participant



________________________________________
Name of Parent / Guardian (if participant is under 18 years of age)

________________________________________
Signature of Parent / Guardian (if participant is under 18 years old)
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