KABVI Membership Application

 

I am enclosing $10.00 for my KABVI dues. 

Name: First  Mid. Init. Last

Address: 

                  

City: 

State:               Zip: 

Phone:           E Mail Address 

Are You:

Legally Blind               Visually Impaired  

Deaf-Blind                    Sighted 

I would like the KABVI NEWS and the BRAILLE FORUM in:

Braille               Large Print  

Disk                   Cassette  

Regular Print               E Mail  

I do not want these publications  

I am including a tax deductible donation to KABVI in the amount of 

$

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