NATIONAL FEDERATION OF THE BLIND OF NEBRASKA

Membership Application Form

 

The National Federation of the Blind of Nebraska has chapters and divisions across the state. The Federation has more than 50,000 members and is working to help the blind to have full and meaningful lives. It is not financed by the government but depends for support on contributions from its members, and its friends.

I support the National Federation of the Blind of Nebraska and herewith pay one dollar for Membership-at-large in the organization. As a Member-at-large I wish to make a tax-deductible contribution for the year ____________ in the amount of:

 

[  ] Associate-$10
[  ] Contributing Associate-$25
[  ] Supporting Associate-$50
[  ] Sponsoring Associate-$100
[  ] Sustaining Associate-$500
[  ] Member of the President's Club-$1,000
[  ] Other _____________

 







(Please type or print legibly.)

Name _____________________________________________________
Street _____________________________________________________
City _______________ State ____________ Zip ______________
Telephone _____________________ Date _____________________

Local representative of the National Federation of the Blind of Nebraska:
Name ________________________________ State ______________

This application and accompanying check made payable to National Federation of the Blind of Nebraska should be sent to:

Associates Program
National Federation of the Blind of Nebraska<
1033 N Street, Suite 24B
Lincoln, NE 68508

 

NFBN Logo with WhozitRECEIPT

Received of ______________________________________
the amount of _________ dollars. Date ______________


_____________________________________________________
Signature of local representative of the National Federation of the Blind of Nebraska

(All contributions to the National Federation of the Blind of Nebraska are tax-deductible. No goods or services, in whole or in part, were provided in consideration of the contribution.)