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Annual Regular Membership – One Time Payment

Annual Regular Membership - One Time Payment

Dues are $15 per calendar year. Annual regular membership is open to anyone over the age of sixteen who supports the mission of BPI. Regular members shall have full voting rights.

"*" indicates required fields

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone

VISION STATUS*

Legally or Totally Blind

Fully Sighted

FORMAT PREFERENCE FOR THE ACB BRAILLE FORUM*

Braille

NLS Cartridge

Large Print

Email

Gender

Female

I identify as female

Male

I identify as male

Non-Binary

Other

I prefer not to answer

Ethnicity

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multi Racial or Multi Ethnic

Native American or Alaskan Native

Native Hawaiian or Other Pacific Islander

South Asian

White-Anglo-Caucasian

Other

I prefer not to answer

Annual Regular Membership - One Time Payment

Price:

Dues are $15 per calendar year. Annual regular membership is open to anyone over the age of sixteen who supports the mission of BPI. Regular members shall have full voting rights.

Payment Method*

Stripe

Square

PayPal

Would you like to add $1.00 to help cover our processing fees for this transaction? This ensures that BPI receives 100% of your membership dues payment*

Yes

No

Total

Pay with Stripe

Card Details

Cardholder Name

Pay with Square

Cardholder Name

Card Details

Pay with PayPal

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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