American Council of the Blind

Of South Carolina

PO Box 481

Columbia, SC 29202

(803) 735 1052

MEMBERSHIP APPLICATION

Top of Form

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

The medium in which you will receive Braille Forum, ACB Magazine. Please check one of the following

Large print: Braille: Cassette: 3.5 inch Computer Disk:

Please include membership annual dues according to location. If your are too far for a support group meeting, you would pay $12.00 and you are considered a Member At Large..

Make checks payable to ACBofSC

Send payments to ACBofSC

PO Box 481

Columbia, SC 29202

Upon receipt of your application and payment, you will receive a state membership packet and be included on the National’s Braille Forum magazine list.

Chapters

Ellen Beach Mack of Columbia Chapter – Location – Columbia ($12.00)

Charleston Tri County Chapter – Location – Charleston ($12.00)

Upper Savannah Regional Chapter – Location – Greenwood ($15.00)