| 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