Guide Dog Users of the Empire State Membership Form

Guide Dog Users of the Empire State Membership and Renewal Form
One year membership is $25.

First and Last Name
Company, agency or business
Street Address
City
State
Zip Code
Email
Phone
Are you a new member or renewing member?

Are you a new member or renewing member? New Member Renewing Member
Are you a guide dog user?

Are you a guide dog user? Yes No
Are you a blind or sighted person?

Are you a blind or sighted person? Blind Person Sighted Person
Choose the format you wish to receive the National ACB Braille Forum:

Choose the format you wish to receive the National ACB Braille Forum: Email Braille Large Print
Would you like to pay online or by check?

Would you like to pay online or by check? Online Check
Comments?
Pay By Check Information

Please note: the ACB of New York newsletter, INSIGHT is only offered via email.
Please make checks payable in the amount of $25 to Guide Dog Users of the Empire State (GDUES)
Mailing address: GDUES
c/o Jim Pulsoni, Treasurer
15 Chestnut Street, Sleepy Hollow, NY 10591
Please contact information@gdues.org if you have any questions or problems with this form. Thank you for donating joining, or renewing with us.
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