APPLICATION-(please print this page)
1. Name:________________________________________________________________________________________________________
2. Address:______________________________________________________________________________________________________
3. City:_______________________________________________
4. State:________________________________________________________________________________ Zip:____________________
5. Telephone:____________________________________ Cell:____________________________________
6. Email:________________________________________________________
7. D.O.B: (month and day only)_____________________________
8. Spouse:___________________________________________________
9. Emergency Contact:_________________________________________
10. Special Interests::___________________________________________
11. Veteran:_____Yes _____No If yes: BOS________________________
12. NFB Member: ____Yes ___No If yes State /Chapter_______________
13. Committee’s you would prefer: ___Fund Raising ____Membership
_____Events _____Sunshine _____Resolutions____Other,explain___________________________________________________________________________________
_________________________________________________________________________________________________________________
Dues are $5.00 per year as specified by the National Board.
Make Checks payable to: NABV
Mail Checks and application to: NABV ,
259 Regal Downs Circle,
Winter Garden, Fl. 34787