Arizona Council of the Blind, INC. 3124 E. Roosevelt St., Ste. 4 Phoenix, AZ 85008-5088 (602) 273-1510
MEMBERSHIP APPLICATION
Membership in the Arizona Council of the Blind is an adventure we want you to share. We hope you will get involved.
The Arizona Council of the Blind gives you a voice in our state and nation. Come, take our hand, and join our adventure.
Fill in the form below and submit and we will send you a Self Addressed Envelope. Just put your payment in the envelope, seal and send it back and you will be a member of the Arizona Council of the Blind and the American Council of the Blind.
Payment for new members of the Arizona Council is $10.00. Renewal fee is $10.00. Is this a renewal or a new member application? (Check one): New Member Renewal TODAY'S DATE (MM/DD/YYYY): BIRTHDAY (MM/DD/YYYY): Check one: Name: Address Line 1: Adress Line 2: City: State/Province: ZIP Code/Postal Code: Telephone: Phone AREA CODE: Phone NUMBER: Email Address: OCCUPATION: Vision - CHECK ONE: Vision is Sighted Vision is partially Sighted Vision is Blind
NEWSLETTER PREFERENCE for Fore-Sight (newsletter of the Arizona Council) Check one: Arizona Newsletter on Audio Tape Arizona Newsletter in Large Print Do Not Send Arizona Newsletter Do not send. ACB BRAILLE FORUM (newsletter for NATIONAL) check one: National Newsletter in Large Print National Newsletter on Cassette Tape National Newsletter in Braille National Newsletter on Computer Disk Do Not Send National Newsletter
Submit will send an E-mail of this form to the AZCB. If you are asked for an address please use tom@azcb.org Click here when your information input has been completed Arizona Council of the Blind Home Page.