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): LP, Half Speed Cassette, Computer Disk, Braille or E-mail

Format for NJCB Chronicle: LP__, Cassette__, E-Mail__

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

Make check payable to MCAB and send to Larry Morgan , Treasurer at the above address. If you have any questions, call Mustafaa at (609) 695-4203

Sincerely,
Mustafaa Shabazz, President