National Federation of the Blind of Connecticut

NFB Newsline Subscription Form

Mailing Address:
477 Connecticut Boulevard, Suite 217, East Hartford, CT 06108

I am registered with a state or private rehabilitation agency for the blind.

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If yes, please specify

I am enrolled in a public school special education program for the blind or state residential school for the blind.

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I am registered with a cooperating regional library under the program of The National Library Service for the Blind and Physically Handicapped, Library of Congress.

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If you answered no to all the above questions, you must include with this application a letter from one of the following certifying that you are blind, visually impaired, or unable to read newsprint due to a disability

Select One:

Doctor Social Security Award Letter President of chapter or affiliate of the NFB Teacher of the visually impaired

I would like to receive information in the following format.

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Large Print Braille CD Electronic

*ALL FIELDS ARE REQUIRED

Name (Full)

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Address

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City

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State

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Zip

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Telephone

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E-Mail

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Please enter your initials and the date to certify that your are blind, visually impaired, dyslexic or have a physical disability and are unable to read a printed newspaper.

Initials

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Date

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NFB Newsline Subscription Form

Mailing Address:477 Connecticut Boulevard, Suite 217, East Hartford, CT 06108

Mailing Address:
477 Connecticut Boulevard, Suite 217, East Hartford, CT 06108