Arizona Council of the Blind, INC.
16845 N 29th Ave, Suite#139
Phoenix, AZ 85053
Membership in the Arizona Council of the Blind is an adventure we want you to share. We hope you will get involved.
The Arizona Council of the Blind gives you a voice in our state and nation. Come, take our hand, and join our adventure.
If you have comments, please use the comment field on the form to leave a note of less than 240 characters for the AzCB. Thank you for your interest and if you have any questions or need help please email the webmaster.
Fill in the form below and submit.
Is this a renewal or a new member application? (select one):
Select an Application Type
New Member Application
There are several Affiliates which you can join to be in a group with more focused issues and with extra social activities. You must check the AzCB box if you are not a member for the year you are filling the application out for. If you wish to be in any or all the Affiliates, check the box for that group. The amount field is the total of all the boxes checked. This is the amount you will put in the PayPal field.
Dues is the sum of State (AzCB) Membership plus the dues charged if you wish to also be a member of one or more Affiliates. Here is the listing of how much items costs:
Total all the boxes checked and put amount here ($10.00 just the State Membership to $33.00 for all the Affiliates)
Total of AzCB and Affiliate Memberships:
* Full Name:
* Address line 1:
Address line 2:
* State or Province:
* Zip Code:
* Full Phone Number including area code:
Select your vision status:
Select your current vision status
You are able to receive both the State and National newsletters. In this section of the application, you can select the format type for each newsletter.
Select Fore-Sight Newsletter Distribution Format:
Select your preferred Fore-Sight Newsletter format
Arizona Newsletter on Audio CD
Arizona Newsletter in Large Print
Arizona Newsletter sent via Email
Arizona Newsletter in Braille
Do Not Send Arizona Newsletter
Select Braille Forum Newsletter Distribution Format:
Select your preferred Braille Forum Newsletter format
Braille Forum Newsletter on Audio CD
Braille Forum Newsletter in Large Print
Braille Forum Newsletter sent via Email
Braille Forum Newsletter in Braille
Do Not Send Braille Forum Newsletter
Select your payment type for your selected dues
I will use Paypal to electronically submit my payment
I will mail in my payment to the AZCB office
How did you hear about AzCB?:
Select an option
Learned about AzCB from Friend
Learned about AzCB from Radio/TV Show
Learned about AzCB from Web Search
Learned about AzCB from Newsletter
Learned about AzCB from Other Source
If other please tell us how?:
Submit will send an E-mail of this form to the AZCB.
Return to AzCB Web Site