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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: ____

Format for Braille Forum (ACB National's Newsletter): LP __ Digital Cartridge __ Braille __ E-mail __ 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