California Council of the Blind

Membership At-Large Application

Printable Application for At Large Membership

At Large membership is any person who does not reside within reasonable
traveling distance of the meeting place of a Council chapter or for other
good cause cannot actively join his/her local Council chapter may become a
Member at Large. Determination of such eligibility shall be made by the CCB
President, subject to review by the Board of Directors.

California COuncil of the Blind At-Large Printable Membership Form

My 'Blind Californian' magazine reading format preference is:
Please check one:
Braille _____
Diskette ______
Large Print (18 point) ______
Audio Cassette Tape ______
Email Subscription: ____

Name:
Street address:
City, State, Zip Code:
Home telephone number:
Home E-mail Address:
Business E-mail Address:
Work telephone number:
Work E-mail Address:

Please return this filled out printable form. If you wish to become a Member-At-Large please return this card filled out and include a $10 payment for annual dues to (check or money order should be made payable to "California Council of the Blind"):

1510 J. Street
Suite 125
Sacramento, CA 95814
Phone: (916) 441-2100
Toll-Free in CA: (800) 221-6359
Fax (916) 441-2188
E-mail: ccotb@ccbnet.org

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