NFBNJ Technology Division Membership Form

The NFBNJ Technology Division is a great networking tool for blind and visually impaired technology users throughout New Jersey. Dues are $5 per calendar year. We meet via Zoom throughout the year and in person at the annual National Federation of the Blind of New Jersey state convention.

For more information contact Jane Degenshein, President, at 973-736-5785.

If you already have paid by check or money order, please simply complete this form for our records. No additional payment is needed for the current calendar year. If you pay dues between October and December of the current calendar year, it will be counted towards the following calendar year.

Please note that refunds will not be issued if you join the wrong chapter or division.

This form can only be submitted for residents of New Jersey. If you are not a resident of New Jersey, then you will not be able to submit this form.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Email*
Enter Email Confirm Email
*
I understand that this membership form is for the NFBNJ Technology Division.
*
I understand that a refund will not be issued if I join the wrong chapter or division.
Membership Status*
Are you blind/vision impaired?*
Are you a parent of a blind child?*
Are you a blind parent?*
Are you a blindness professional?*
Please designate which area of profession you work in*
- Orientation & Mobility Instructor
- Teacher of Blind Students
- Rehabilitation Professional
Are you a guide dog user?*
Do you use a white mobility cane?*
Date of Birth
Prefered Media Format*
This is for the NFB national office’s information only for the Connections database.
Prefered contact method*
NFBNJ Technology Division Membership Dues*
Price:
Number of Years*
Dues are $5 per calendar year. You can pay for more than one calendar year at a time.
Total
$0.00
Payment Method*
You can pay using PayPal or a credit or debit card.

If paying via check or money order, please make the check or money order payable to NFBNJ Technology Division with "Tech Div dues [year(s) you are paying dues for]" in the memo field. Please send to:
Annemarie Cooke
7 Mayfair Road
Southampton, NJ 08088

Thank you again for paying your membership dues to the NFBNJ Technology Division.