RSVA ®

Randolph-Sheppard
Vendors of America^®

Blind Businessmen and Businesswomen
Building a Better America

Member of

SAGEBRUSH

RSVA^®

RESOURCES


Home	Sagebrush

The RSVA^® 2021 SAGEBRUSH
CONFERENCE REGISTRATION FORM

Name:
Mailing Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Are you a First Time participant? Please select Yes or No. YES No
Select if you do wish to share or not share your contact information with other participants, exhibitors and sponsors. Do Share Do NOT Share "Do Share" is the default
Check all boxes that apply if you are: a Vendor a Spouse a Guest Speaker BEP-Staff Administrator Other
Check if you prefer Media Format: Large Print Braille CD Email
Please read the RSVA^® Code of Conduct. Check here to verify I have read and understand the RSVA^® Code of Conduct Policy

Standard Registration Early Registration Fee is $35 online. Registration Fee after January 13, 2021, is $50 online.
Today is 04/25/2024	Registration Amount Today is	$50
Other events and items not covered in registration fee.
Become Lifetime Member, $200	$200
Become RSVA^® member and receive Vendorscope: $10.00	$10
RSVA^® 50th Anniversary T-Shirt: $15.00	Click Checkbox if Yes, $15 Quantity Sizes (S M L XL XXL)	$15 x Quantity
RSVA^® 50th Anniversary Polo Shirt: $25.00	Click Checkbox if Yes, $25 Quantity Sizes (S M L XL XXL)	$25 x Quantity
Individual convention sponsorships:	Bronze $25 Silver $50 Gold $100 Platinum $250	$25 $50 $100 $250
Donation Amount:	Enter amount as a whole number only; No decimals and no dollar signs.

You may pay by credit card through PayPal.

NOTICE TO ALL PARTICIPANTS:
Registration is required to receive the Zoom info for full participation in the conference and to have access to door prizes.
Sorry, we are unable to give refunds after January 1, 2021

Registration Fee: Registration will not be complete without payment.

For further information, you may contact RSVA^® Ardis Bazyn at (818) 238-9321
or e-mail: rsva@randolph-sheppard.org.


Home	Sagebrush

Website Maintained by Farmer Host

Contact Webmaster at
help@farmer.host

Randolph Sheppard Vendors of America^®
940 Parc Helene Drive Marrero, LA 70072
Email: rsva@randolph-sheppard.org Website: www.randolph-sheppard.org

The RSVA® 2021 SAGEBRUSH CONFERENCE REGISTRATION FORM

The RSVA^® 2021 SAGEBRUSH
CONFERENCE REGISTRATION FORM