Join / Renew ACBM

Join or renew your ACB Minnesota Membership today! Current members, please use the form below. New Members: Click Here for the First time Registration form

Name*
First Last
Email*
Home Phone*
Cell Phone
Address*
Street Address Address Line 2 City State ZIP Code
Vision*
Which of the following would you identify as?
- Degree of eye sight, Blind
- Low Vision
- Fully Sighted
Gender*
- Gender? Prefer Not To Answer
- Female
- Identify As Female
- Male
- Identify As Male
- Nonbinary
- Other
Ethnicity*
- Ethnicity? Prefer Not To Answer
- Multi-Racial / Multic-Ethnic
- Asian
- Black / African American
- Hispanic / Latino
- Middle Eastern / North African
- Native American / Alaskan Native
- Native Hawaiian / Pacific Islander
- South Asian
- White / Anglo-Saxon
- Other
Birthday
Optional
Age
Optional
- Age Range? Under 30
- 30 to 49
- 50 to 65
- 65 plus
Do you wish to receive the Braille Forum Magazine?*
- Receive ACB Braille Forum? No
- Yes: In Braille
- Yes: In Large Print
- Yes: Via Email
- I Already Receive It
Optional
- Add $1 to help us cover Square’s credit card charges.

Credit Card*

Name On Card

Card Details

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