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NFB-NEWSLINE Subscription Form
December 31, 2020 - 7:39pm —
Brian Mackey
I am registered with a state or private rehabilitation agency for the blind.
*
Yes
No
If yes, please specify
I am enrolled in a public school special education program for the blind or state residential school for the blind.
*
Yes
No
If yes, please specify
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.
*
Yes
No
If yes, please specify
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 -
Doctor
Social Security Award Letter
President of a chapter or affiliate of the National Federation of the Blind
Teacher of the visually impaired
Attached Letter
*
Files must be less than
2 MB
.
Allowed file types:
rtf pdf doc docx
.
I would like to receive information in the following format.
*
- Select -
Large Print
Braille
Electronic
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Phone Number
*
Email Address
Please enter your initials to certify that you are blind, visually impaired, dyslexic or have a physical disability and are unable to read a printed newspaper.
*
Please enter the date to certify that you are blind, visually impaired, dyslexic or have a physical disability and are unable to read a printed newspaper.
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2021
2022
2023
2024
2025
Math question
*
12 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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