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New Jersey Council of the Blind
An affiliate of
American Council of the Blind
MEMBERSHIP AT LARGE
APPLICATION

Name:

Address:

 

Phone Number:

E-Mail Address:

Legally Blind: ____ Visually Impaired: ____ Fully Sighted: ____

Format for Braille Forum (ACB National’s Newsletter): LP__ Half Speed Cassette__ Braille__ E-mail__

Format for NJCB Chronicle: LP__ Cassette__ E-Mail__

Annual Dues: $10.00 due in January

Make check payable to NJCB and send to:
Robert Lucas, Treasurer
520 Ewingville Road
Ewing, NJ 08638-1410

President: John Vernon
whynot48@comcast.net