Mercer County Association of the Blind (MCAB) - Membership Application

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Mercer County Association of the Blind
P.O. Box 55042
Trenton, New Jersey 08638
APPLICATION FOR MEMBERSHIP
Name: __________________________________________________
 
Address: __________________________________________________
 
  __________________________________________________

Phone Number: ______________________________________

E-Mail Address: ______________________________________

Legally Blind: ____ Visually Impaired: ____ Fully Sighted: ____

Format for Braille Forum (ACB National's Newsletter): Braille-ready text__, Digital Cartridge__, Large Print__, Podcast__, E-Mail__

Format for NJCB Chronicle: Large Print__, E-Mail__

Annual Dues due in January
Individual membership: $10.00
Corporate Membership: $25.00

Make check payable to MCAB and send to Nicole Gorman, Treasurer at the above address. If you have any questions, call Wanda at 609-375-6682

Sincerely,
Wanda Williford, President