Braille Literacy Canada | Join or Renew Your Membership

You are signing up for a family membership (for multiple people living at the same address). Please enter the primary contact person's information first. You may then add up to five additional contacts below. If the contact information for the additional family members is the same as the primary member, you do not need to re-enter it. Note that you must enter the name of at least one additional family member to use this form. If you are entering fewer than five, simply leave the unnecessary fields blank.

Primary Member

Contact Information

First Name: *

Last Name: *

E-mail Address: *

Mailing Address (Line 1): *

Mailing Address (Line 2):

City: *

Province: *

Postal Code: *

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Membership Preferences

Preferred language for correspondence:: *

English

French

Preferred format for mailed materials: *

Braille

Additional Information

Are you interested in joining one of our committees or would you like to contribute your time? Please indicate how you would like to get involved and we will contact you. Whatever your interest or strength, BLC encourages you to become actively involved in making this an outstanding organization.

Describe your interest in being involved:

Additional comments:

Family member #2 *

First Name: *

Last Name: *

E-mail Address:

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Preferred language for correspondence::

English

French

Preferred format for mailed materials:

Braille

Family member #3

First Name:

Last Name:

E-mail Address:

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Preferred language for correspondence::

English

French

Preferred format for mailed materials:

Braille

Family member #4

First Name:

Last Name:

E-mail Address:

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Preferred language for correspondence::

English

French

Preferred format for mailed materials:

Braille

Family member #5

First Name:

Last Name:

E-mail Address:

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Preferred language for correspondence::

English

French

Preferred format for mailed materials:

Braille

Family member #6

First Name:

Last Name:

E-mail Address:

Telephone (Home):

Telephone (Cell):

Telephone (Work):

Preferred language for correspondence::

English

French

Preferred format for mailed materials:

Braille

How do you plan to pay your membership dues? *

Online using my credit card or PayPal account after I submit this membership form

Online by sending an Interac e-Transfer to treasurer@blc-lbc.ca after submitting the membership form

Over the phone using my VISA or MasterCard (please call me)

By mailing a cheque or money order to BLC after submitting the membership form

Consents

I have read and agree to Braille Literacy Canada's Privacy Policy, and confirm that I have the permission and authority to agree to the same on behalf of the above-listed family members *

I understand that by becoming members of Braille Literacy Canada, BLC will send me and the above-listed family members communications and correspondence by email *