AMERICAN COUNCIL OF THE BLIND

ONLINE MEMBERSHIP APPLICATION
Georgia Council of the Blind

Name:

Phone:

Street Address:

City:

State:

Zip Code:

E-mail Address:

Are you blind or visually impaired according to the legal definition of blindness? Yes No

If you are not currently receiving the Braille Forum or if you would like to change the medium in which you receive it please check one of the following. Large print: Braille: Cassette: 3.5 inch Computer Disk:

To get the Braille Forum by E-MAIL: see the Braille Forum page for further instructions.

Send the form now

Clear the form

Return to Affiliates page.

ONLINE MEMBERSHIP APPLICATION Georgia Council of the Blind

ONLINE MEMBERSHIP APPLICATION
Georgia Council of the Blind