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.

* 1. Please provide your personal information:

* 3. Date of Birth

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

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

* 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?

* 7. 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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