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IOWA COUNCIL OF THE UNITED BLIND (ICUB)

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Event Sign-Up Form

2025 ICUB Convention and Conference
“Making the Future Bright: A Vision for Tomorrow.”

Before filling out the sign-up form below, you can review the event details by downloading the Event Packet using the buttons below. The first button is for the Microsoft Word version, the second is for the PDF version.

Download Event Info Word Document

Download Event Info PDF

Once you have read the Event Packet, fill out the form below to sign up. Registration is $25. Meals are extra and denoted below:

2025 Convention Sign Up Form

Enter your contact information and make your meal selections below. Each registrant must fill out the form separately:

Enter Your First Name

Enter Your Last Name

Enter Your Email Address

Enter Your Phone Number

Street Address

City

State

Zip Code

WILL YOU BE ATTENDING IN PERSON OR OVER ZOOM? *

I will be attending in person.

I will be attending over Zoom.

SELECT THE BREAK-OUT SESSIONS YOU'D LIKE TO ATTEND

Audio Described Movie at Flix Brewhouse

Des Moines Historical Society Tour with Navi Lens

SELECT BREAKFAST OPTION ($18)

The Iowan – Two scrambled eggs, breakfast potatoes, and bacon, fresh pastry and choice of beverage.

Biscuits and Gravy – Two buttery biscuits topped with country gravy, served with scrambled eggs, fresh pastry, and choice of beverage.

Breakfast Burrito – Scrambled eggs, sausage, peppers, onion, and shredded cheese inside a flour tortilla, served with sour cream, salsa, breakfast potatoes, fresh pastry and choice of beverage.

SELECT LUNCH OPTION ($25)

Frenchie’s Roasted Beef – Roast beef layered in a bun, topped with French onion dip and crispy shallots, served with potato salad, fresh fruit, cookie, and iced tea or lemonade.

Pasta Primavera – Penne pasta tossed in a house-made Alfredo sauce and vegetables, topped with Asiago cheese, served with fresh baked bread and iced tea or lemonade.

Chicken Salad Croissant – The chef’s specially made chicken salad on a flakey croissant, served with pasta salad, cookie and iced tea or lemonade.

SELECT BANQUET OPTION ($42)

Parmesan Crusted Sirloin – 6-ounce steak with a grated parmesan cheese crust, served with Garlic mashed potatoes, vegetables, House salad, fresh roll, Mascarpone Cake, and iced tea or lemonade.

Iowa Pork Chop – Center-cut grilled pork chop with maple demi-glaze, served with fingerling potatoes, vegetables, House salad, fresh roll, Mascarpone Cake, and iced tea or lemonade.

Arancini Vegetable Stack – Chef’s selection of vegetables with polenta and a balsamic reduction, served with House salad, fresh roll, Mascarpone Cake, and iced tea or lemonade.

ADDITIONAL DONATION AMOUNT (OPTIONAL)

PAY ELECTRONICALLY OR BY CHECK *

I would like to pay electronically.

I would like to pay by check.

When you submit this form with the button below, you will receive a confirmation email. After that, if you elected electronic payment, you will receive another email with a link to make your payment. If you elected to pay by check, please send it to Jeana Mowery, Treasurer, 1402 Brentwood Terrace, Marshalltown, IA 50158 . Make checks payable to the Iowa Council of the United Blind or "ICUB". Thank you!

Thank you for registering! You will receive an email confirmation shortly. If you do not see it within 15 minutes, please check your spam folder. Thank you! See you at the event!

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Contact us

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Telephone: 1-866-436-0141

304 W Cedar Street, Goldfield, Iowa, 50542

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An Affiliate of the American Council of the Blind (ACB)

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Thank you to the Greater Iowa Credit Union (GICU) for providing financial support for this website.

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