MEMBERSHIP APPLICATION


Name_________________________________                                              
   

Address________________________________                                             


City______________ State_________ Zip______         

   
Telephone No._______________                                        


DOB_____________ Male_____ Female_____     


Vision Impaired______ Sighted______    


I would like the quarterly issues of the 
NDAB Promoter and monthly issues of the 
ACB Braille Forum in (check one)

____Cassette     ____Large Print
____Braille      ____E-mail

My E-mail address__________________

Date of Application________________                     

Annual Dues-$15.00

Please include $15.00 check payable to NDAB

Mail to: 

NDAB
C/O Milissa Miller 
1813 6th Ave S
Fargo, ND 58103



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