2021 USABA Breakfast with Champions Virtual Registration

Thank you for registering for the 12th annual virtual USABA Breakfast with Champions!

We are thrilled to be offering the Breakfast with Champions this year as a virtual event for all across the country. Breakfast with Champions is the United States Association's annual fundraising event for our athletes and members across the US who are blind and visually impaired.

This event will be virtually hosted on Friday, October 29, 2021, 8:15 am MDT. Information regarding virtual attendance at the Breakfast via Zoom or Facebook will be sent to the email you specify below the week of the event.

REGISTRATION CLOSES THURSDAY, OCTOBER 28, 2021, AT 12:30pm MDT

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* 1. Please enter your contact information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

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* 2. Would you like to sign up to receive the USABA Newsletter?

Yes

I already subscribe to the USABA Newsletter

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* 3. Which of the following best describes you? (Select all that apply)

USABA Member

USABA Friend/ Donor/ Supporter

Corporate Partner

USOPC/ NGB Staff

Other (please specify)

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* 4. As a virtual attendee, there is not a charge for the event. However, we ask you to please consider making a donation to support the needs of our athletes. The following highlights possible uses of funds raised at the 12th annual USABA Breakfast with Champions

$45 USD purchases a set of USABA eyeshades - $45 USD

$95 USD purchases a pre-fabricated goalball court - $95 USD

$245 USD provides a registration fee for a blind or visually impaired athlete to attend a USABA ski camp - $245 USD

$495 USD purchases an equipment kit for a new blind soccer team - $495 USD

$995 USD provides training for an aspiring Paralympian hoping to qualify for the Paris 2024 Paralympic Games - $995 USD

Other (please specify)

Minimum amount: $1 USD

You will pay at the end of this survey.