FIRST NAME (Required)

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EMAIL

WHAT IS YOUR VISUAL ACUITY?TOTALLY BLINDLOW VISIONFULLY SIGHTED

BIRTHDAY

WHAT IS YOUR FORMAT PREFERENCE FOR NEWSLETTERS & CORRESPONDENCE?EMAILBRAILLELARGE PRINT

IS IT OK TO SHARE YOUR NAME ON OUR PUBLIC MEMBERSHIP ROSTER?YES - OK TO SHARENO - DO NOT SHARE

GENDER IDENTITY PREFERENCE?FEMALEI IDENTIFY AS A FEMALEMALEI IDENTIFY AS A MALENON-BINARYOTHERI PREFER NOT TO ANSWER

RACE / ETHNICITY?ASIANBLACK OR AFRICAN AMERICANHISPANIC OR LATINOEMIDDLE EASTERN OR NORTH AFRICANMULTI-RACIAL OR MULTI-ETHNICNATIVE AMERICAN OR ALASKAN NATIVESOUTH ASIANWHITEOTHERI PREFER NOT TO ANSWER

MEMBERSHIP PREFERENCE?MEMBER-AT-LARGEMEMBER OF A CHAPTER

WHICH CHAPTER OR AFFILIATE ARE YOU INTERESTED IN JOINING?

DUES AND MEMBERSHIP FEES

CHOOSE YOUR DUES$11.00 - FOR STATE AND NATIONAL DUES$5.00 - FOR NATIONAL DUES ONLY$6.00 - FOR STATE DUES ONLY$500.00 - FOR STATE + NATIONAL LIFETIME MEMBER

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