MCBVI Member At Large Application – Michigan Council of the Blind and Visually Impaired

If you wish to be a member of a local chapter, contact the treasurer of the specific local chapter you wish to join. For a list of MCBVI’s local chapters, go to the Chapters Page.

To join as a member at large, complete this form. Fields with an asterisk are required.

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Communication Preferences

I would like to receive the ACB Braille Forum in:

General "At Large" Membership is only $10

I am sending my annual dues by check or money order

I will pay online ($1.00 charge, $11.00 total)

Make checks payable to the MCBVI in the amount of $10

Payment Method

Membership With Paypal

Price:

Total