GDUI

GUIDE DOG USERS, INC.
MEMBERSHIP APPLICATION

* NAME(S):

ADDRESS:

CITY:

STATE:

ZIP CODE:

COUNTRY:

* HOME PHONE, WITH AREA CODE:

WORK PHONE, WITH AREA CODE:

* E-MAIL ADDRESS:

GDUI MEMBERSHIP DUES
$15.00 PER YEAR (INCLUDES PAWTRACKS SUBSCRIPTION

SUBSCRIPTION TO PAWTRACKS WITHOUT GDUI ACB MEMBERSHIP, $25.00 PER PERSON PER YEAR

GDUI LIFE MEMBERSHIP, $250 PER PERSON (May be paid in monthly installments)

IF YOU ARE NOT CURRENTLY RECEIVING THE BRAILLE FORUM, OR IF YOU WISH TO CHANGE THE MEDIUM IN WHICH YOU RECEIVE IT, PLEASE CHECK ONE OF THE FOLLOWING:
BRAILLE

LARGE PRINT

4-TRACK CASSETTE

TO RECEIVE THE BRAILLE FORUM VIA E-MAIL, SEND A MESSAGE TO BRAILLEFORUM-L-SUBSCRIBE@ACB.ORG.

PLEASE PROVIDE US INFORMATION CONCERNING YOUR DEGREE OF VISUAL IMPAIRMENT BY MARKING ONE OF THE CATEGORIES BELOW:
TOTALLY BLIND

PARTIALLY SIGHTED

FULLY SIGHTED

MEDIUM PREFERENCE FOR INDIVIDUAL COMMUNICATIONS FROM GDUI:
LARGE PRINT

BRAILLE

MEDIUM PREFERENCE FOR PAWTRACKS:
4-TRACK NLS-FORMAT CASSETTE (FOR LEGALLY-BLIND MEMBERS ONLY)

AUDIO COMPACT DISK (4 DISKS PER ISSUE)

MP3 COMPACT DISK (1 DISK PER ISSUE)

MP3 DOWNLOAD

GDUI

GUIDE DOG USERS, INC. MEMBERSHIP APPLICATION

GUIDE DOG USERS, INC.
MEMBERSHIP APPLICATION