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Application Form For ABA Membership.

Please Note: The information you give on this form is kept Confidential and is only for the use of ABA’s Office records. The information you give is not given to any unauthorised person or any group or Organisation, without the clearly expressed permission of the member concerned

Notes

• Full membership is open to Blind and Partially Sighted people of Asian Origin and is free.
• Full membership is also open for the Blind and Partially Sighted non-Asian spouses of people of Asian origin.
• Associate Membership is open for sighted people or people with other disabilities with the life membership fee of £15. If you are applying for Associate Membership, please make the cheque payable to Association of Blind Asians and along with the completed application form,
  post it to our office,
  thank you.

Please answer all the questions below, before submitting the form to ABA. Thank you for your co-operation and your application to become a member. If you have any queries please
Contact our office.
for further clarification.

Application Form For Membership of ABA

Date (form completed): 05 January 2009

Title: Mr Mrs Miss Ms Dr

First Name(s):

surname:

House or Building Name:

House number and street:

Address 2:

Town or city:

County:

Postcode:

Your home telephone number:

Email address (if any):

Date of birth:

Have you ever been a member of ABA?
No Yes

if Yes, how long ago did you cease contact with ABA and, what was the reason?

Do you understand English?
Yes No

Which is your preferred language?

What is your eye condition called? Give a brief description (if applicable to you):

I am (please select one of the following): Registered blind. Registered partially sighted. Fully sighted.

Name of Local Authority you are registered with (if applicable):

The year of your registration as blind or partially sighted (if applicable):

If you are registered blind or partially sighted, would you like to receive ABA’s monthly tape magazine? Yes No

What is your preferred reading format: Braille. Large print. Audio. Email. Standard print.

What is your second preferred reading format? None. Braille. Large print. Audio. Email. Standard print.