GOPBC Membership Form
Please print and mail with your payment to the address below.

I would like to join the Georgia Organization of Parents of Blind Children. Enclosed is my $10.00 GOPBC membership fee, which includes membership to the National Organization of Parents of Blind Children and subscriptions to Future Reflections and The Braille Monitor.  

(Please make checks payable to: NFB of Georgia.)

Name: _______________________________________________________________

Address: _____________________________________________________________

City, State, Zip: ________________________________________________________

Telephone: ____________________________________________________________

E-mail: _______________________________________________________________

Name of child: _________________________________________________________

Child's birth date: _______________________________________________________

Please check all that apply:    (   ) Parent   (   ) Teacher    (   ) Other: ____________________

Please send me the following FREE item(s):

(   )       Future Reflections introductory issue and packet

(   )       Braille literacy packet

(   )       Packet for teachers and aides

(   )       Cane travel (O&M) packet

(   )       Early childhood packet

(   )       IEP/IDEA '97 packet 

(   )       Other: _____________________________________________________________

Checks should be made payable to NFB of Georgia.

If you are not interested in joining, please consider making a donation.  

Membership applications, checks, and requests for additional information should be mailed to:

GOPBC
P. O. Box 941835
Atlanta, Georgia 31141-1835

(404) 371-1000 ext. 31

E-mail: president@gopbc.org