Membership form: Canadian Council of the Blind, Toronto chapter
This form captures membership information for your CCB Toronto Visionaries membership. Do not enter any credit card information in this form, that will be handled separately through a PayPal transaction.
Email *
Would you like to be added to our e-mail distribution list to receive announcements about upcoming chapter activities and other community information via e-mail?
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First name (required) *
Family name (required) *
Phone number
Phone extension (if any)
Street address and unit number (required) *
City (use spacebar to select Toronto, down arrow to select other and type your city) *
Required
Province (use spacebar to select Ontario, down arrow to select other and type your province) *
Required
Postal code (required) *
Physical address, if different from mailing address
Please check the category that best applies to you. Use the spacebar to select. *
Required
Preferred language (spacebar to select, arrow keys to move between choices) *
Required
Member since (year). This is optional.
Date of birth (day, month, year). This is optional.
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A copy of your responses will be emailed to the address you provided.
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