NFB-NEWSLINE(R) Texas Program Application

The National Federation of the Blind of Texas is offering any legally blind Texan who completes
this application the opportunity to be entered in a drawing for a $100 cash prize. Drawings will be held on a quarterly basis.  Winners will be notified via telephone or email.

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* 1. Please provide your personal information:

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* 2. Are you legally blind?

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* 3. Date of Birth

Date

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* 4. Do you currently receive services from any of the following? Check all that apply

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* 5. Please answer all that apply. I am:

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* 6. Are you a current subscriber to NFB-NEWSLINE(R) Texas, the free, audio newspaper and
information service sponsored by the National Federation of the Blind of Texas?

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* 7. How did you learn about NFB-NEWSLINE(R) Texas?

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* 8. May we use the contact information you have provided to keep you updated about programs and activities sponsored by NFB-NEWSLINE(R) Texas and the National Federation of the Blind of Texas?

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