Name: ________________________
Street Address: ____________________________
City: __________________ State/Zip: __________________
Phone Number: ________________
Email Address: ________________________
1. Please check one:
Sighted ____ Partial ____ Blind _____
2. Please circle preferred format for "ACB Braille Forum"
Braille Large Print Cassette Email Data CD
3. Please circle preferred format for "Sightings"
Large Print Email
Please make your $20 check payable to "WyCB" and remit to:
WYCB
2436 S. Poplar St.
Casper, WY 82601