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Canadian Council of the Blind Membership Form
Please fill in this form and pay the $10 annual membership fee to become an independent member of the Canadian Council of the Blind
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Name *
Street Address *
City, Province *
Postal Code *
Phone *
Email *
Category *
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Language Prefrence
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Optional Information (for membership demographics)
Date of Birth
Approval from Parent/Guardian (if Youth Member) Please provide name and contact information.
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