Membership form: Canadian Council of the Blind, Toronto chapter

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This form captures membership information for your CCB Toronto Visionaries membership. Do not enter any credit card information in this form, that will be handled separately through a PayPal transaction.

Email *

Would you like to be added to our e-mail distribution list to receive announcements about upcoming chapter activities and other community information via e-mail?

Yes, add me to your distribution list.

No, do not add me to your distribution list.

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First name (required) *

Family name (required) *

Phone number

Phone extension (if any)

Street address and unit number (required) *

City (use spacebar to select Toronto, down arrow to select other and type your city) *

Toronto

Other:

Required

Province (use spacebar to select Ontario, down arrow to select other and type your province) *

Ontario

Other:

Required

Postal code (required) *

Physical address, if different from mailing address

Please check the category that best applies to you. Use the spacebar to select. *

Blind

Visually-impaired (low-vision)

Sighted

Honourary

Associate or volunteer

Required

Preferred language (spacebar to select, arrow keys to move between choices) *

English

French

Required

How did you hear about the CCB Toronto Visionaries?

Web search (for example, a Google search)

Other community organizations (for example, CNIB or Balance for Blind Adults)

Social media (for example, Facebook, Twitter, Instagram, etc.)

Friends or relatives

Other:

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Member since (year). This is optional.

Date of birth (day, month, year). This is optional.

YYYY

A copy of your responses will be emailed to the address you provided.

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