VIISA I Conference Registration 2025 Survey

1.Full Name:(Required.)

2.Phone:(Required.)

3.Email address:(Required.)

4.Would you like to be added to the MSB Outreach Professional Development email list? (we promise not to spam you!)

Yes

5.Current Job Position:(Required.)

6.Agency/Program/School District:(Required.)

7.Are you currently serving a child with low vision/blindness?(Required.)

Yes

If known, please list any eye conditions of children you serve:

8.Will you be able to attend both November sessions?(Required.)

Yes

9.Please list any needed ADA accommodations (i.e. language interpretation, reading medium, braille, etc ). Please note, any requests made after October 29TH cannot be guaranteed, although we will make every effort to meet them:

10.We will be providing lunch to all each full day of the event.

We know we can't accommodate everyone's tastes and diets, so ask that if you have any strict allergies or restrictions that you plan to bring your own packed lunch. Refrigeration space and microwaves are available upon arrival.(Required.)

I understand!

Current Progress,

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VIISA I Conference Registration 2025

VIISA Course I: Early Intervention for Infants and Toddlers with Vision Impairment/Blindness