Become a part of our community
AT THE COMPLETION OF THIS MEMBERSHIP FORM WHEN YOU CLICK THE BUTTON YOUR FORM WILL BE SUBMITTED FOR PROCESSING AND YOU WILL BE REDIRECTED TO PAYPAL'S SECURE SITE TO INPUT AND COMPLETE YOUR PAYMENT OF FEES. A PAYPAL ACCOUNT CAN BE USED BUT IS NOT REQUIRED. FOLLOW PAYPAL'S INSTRUCTIONS TO PAY WITH YOUR OWN PAYPAL ACCOUNT, CREDIT OR DEBIT CARD.
STATENCAKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
WHAT IS YOUR VISUAL ACUITY?TOTALLY BLINDLOW VISIONFULLY SIGHTED
WHAT IS YOUR FORMAT PREFERENCE FOR NEWSLETTERS & CORRESPONDENCE?EMAILBRAILLELARGE PRINTCARTRIDGE
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 CHAPTERMEMBER OF AN AFFILIATE
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
BY CHECKING THIS BOX YOU ARE INDICATING THAT YOU HAVE REVIEWED THIS FORM AND AGREE THAT ALL INFORMATION IS CORRECT. THE BUTTON BELOW WILL TAKE YOU TO SECURE PAYPAL PAYMENT OPTIONS BUT WILL NOT WORK UNTIL YOU HAVE CHECKED THIS BOX.
