Annual Meeting Dinner

Save The Date!
Wednesday April 18, 2018
5:30 P.M.
Cost: $20 per person

Wayside Inn
6638 PA ROUTE-61
Shamokin, PA 17872

ANnual DInner Sign-up Form

Fill out and submit this computer form or download our newsletter (in March) or call the office for paper forms.

Cost is $20.00 per person - includes dinner, ceremony and entertainment. You will be sent to the payment page when you click submit

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Individual/Self Advocate Attending *

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Email *

Individual/Self Advocate Phone Number *

County *

Staff Attending *

Staff Phone Number *

Agency Represented *

Guest(s) Attending *

Guest Phone Number *

Total Number Attending *

Choose how you will get there... (Note: van seating is limited and is first-come first-served) *

I need a ride in the Arc Van! I will get there on my own

Please note: The Arc Van is NOT handicapped accessible.

By clicking submit for any of The Arc, Susquehanna Valley events, I grant its representatives and employees the right to take photographs of me and my property. I authorize this organization, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that The Arc, Susquehanna Valley may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertisement and web content

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What Our Clients Are Saying

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"Very Skilled!"

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"Cheryl is a huge asset to the program."

"Very knowledgeable about different disabilities. They know how to engage the kids and plan many activities."

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