Membership Application
Name
________________________________________________________
Address
______________________________________________________
Phone
# _____________________________
DOB
__________________ Male ___ Female ___
Vision
Impaired ____Sighted ____
Date
of Application _____________________
Annual
Dues - $15.00 (After initial payment, dues are paid every February 1st.)
I
would like the quarterly issues of the NDAB Promoter and monthly issues of the
ACB Braille Forum in (check one)
Large Print _____ Cassette tape _____ Braille _____ E-mail_____
Please
make $15.00 check payable to NDAB and mail to:
Milissa
Miller