DBLNJ

DBLNJ is a non-profit organization with 501(c)3 tax-exempt status
©Copyright 2013; DBLNJ All rights reserved.

Membership Form 2020

             Deaf-Blind League of NJ
             2020 Membership Form


        REDUCED MEMBERSHIP FEE
             $10.00 PER PERSON

           

           New______ Renewal_____


(PLEASE PRINT)
NAME:


ADDRESS:


HOME PHONE #:


WORK PHONE #:


E-MAIL ADDRESS:


   DEAF____ H/H___HEARING______


         BLIND_____ SIGHTED____


ANNUALLY, A PRINTED DIRECTORY GOES OUT TO MEMBERS. PLEASE SELECT THE CONTACT INFORMATION YOU WANT IN THE PRINTED DIRECTORY.


___ NAME
___ MAILING ADDRESS
___ PHONE NUMBER
___ EMAIL ADDRESS


How would you like to get your DBLNJ correspondence?
Email_____ Mail_____ Braille______

 

MEMBERSHIP DUES: $10.00 per person
 

SEND MEMBERSHIP FORM WITH A CHECK PAYABLE TO DBLNJ TO:

Julie Troger
44 Ravenslake Rd 

Monroe Township, NJ 08831


  THANK YOU FOR YOUR SUPPORT!