Join PCB - Pennsylvania Council of the Blind

Name

First

Last

Date of Birth

day

month

year

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

County of residence:

Home Phone

Cell Phone

Please note: All members will be automatically added to PCB's email distribution list. Announcements of events, opportunities, and resources are sent out 2 to 3 times each month. For members without email access, PCB posts monthly updates to the PCB Information Line, available by calling 773-572-6314.

Preferred Format of Material:

Braille

Large Print

Audio/NLS Cartridge

Are you a person with vision loss or blindness?

Yes

If you wish to tell us about any disabilities other than vision loss or blindness, please do so here:

Select your annual network membership type:

Individual Adult At-Large

Individual Junior (under 18)

Nonprofit Agency

Corportate/For Profit

Are you interested in being listed in a database of individuals who provide peer support to others impacted by vision loss? Please note, your name, email, and telephone information will be shared with individuals who contact the PCB office seeking peer guidance.

Yes

If yes, what type of experience or expertise might you be comfortable providing? (eg. assistive technology, parenting, organizing, a specific occupation, language fluency, etc.)

If you are seeking vision loss resources, please tell us more about your needs so we can best offer assistance.

Please note: PCB program coordinators will contact you to provide or gather additional information based on your responses to all questions.