VIISA Conference Application

Course 2 - 2022-2023

Session 1: November 2-4, 2022

Session 2: April 19-21, 2023

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* 1. Full Name:

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* 2. Phone:

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* 3. Mailing address (street, city, state, zip):

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* 4. Email address:

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

Yes

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* 6. Current Job Position:

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* 7. Agency/Program/School District:

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* 8. Are you currently serving a child with low vision/blindness?

Yes

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

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* 9. Will you be able to attend both the November 2-4, 2022 session and the April 19-21, 2023 session?

Yes

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* 10. Please list any needed accommodations (i.e. language interpretation, reading medium, dietary restrictions). Please note, any requests made after October 11 cannot be guaranteed, although we will make every effort to meet them:

Conference is provided free of charge. Working lunch will be provided on Thursday and Friday of each session. Transportation, lodging, and other meals will be the responsibility of the applicant.