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2026 ACB Indiana + Ohio Convention Registration
Name
*
Street Address
*
City
*
State
*
ZIP Code
*
Email Address
*
Phone Number
*
Program Medium
*
A
Email
B
Braile
C
Large Print
Do you need an assistive listening device?
*
A
Yes
B
No
Guide dog's name
*
Can we include you in photos & videos during the convention?
*
A
Yes, you may take photos and videos of me
B
No, do not take photos or videos of me
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