New Jersey Council of the Blind
An affiliate of
American Council of the Blind
MEMBERSHIP AT LARGE
APPLICATION
Name: ______________________________________________________
Street: ______________________________________________________
City: ________________________________________________________
State: ______________________Zip: _____________________________
Phone Number: _______________________________________________
E-Mail Address: ______________________________________________
Meeting reminder notification format: Email: ___Text: ___
Legally Blind: ____ Visually Impaired: ____ Fully Sighted: ____
Preferred format for Braille Forum (ACB National's Newsletter): Large Print __ Digital Cartridge __ Braille-Ready Text __ E-mail __ Podcast __ None___
Format for NJCB Chronicle: E-Mail _____Online _____
Annual Dues: $10.00 due in July
Make check payable to NJCB and send to:
NJCB Treasurer
PO Box 434
Woodbridge, NJ 07095
848-999-2079