2022 Human Services Division Registration

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First Name *

Last Name *

Email Address *

What State are you from? List all that apply. *

Are you a member of a National Federation of the Blind State Affiliate? List all that apply. *

What's your Profession (Counselor, Social Worker, etc.)? *

Are you a student? *

Yes

At the end of our division meeting, we will have an opportunity for breakout discussion sessions. Which of the following sessions would you like to participate in? *Please note: Whichever choice you make is not irreversible. If you make a selection and decide you would like to change by the time of the meeting, that is acceptable. *

General Discussion

Career Networking Discussion

Licensure Discussion

Discussion about the Division

In order to become a member, renew membership, or vote in elections, you must pay $5. How will you be paying your dues? *

Electronically

Via Mail (Check)

None. I do not wish to become a member.

Below is the link for electronic payment. Once you've paid, come back to this form and check yes to indicate you've paid. Make sure to select the correct division. http://www.nfb.org/divisiondues

Yes, I've paid membership dues electronically.

No, I will be mailing in my dues.

I am not paying dues. I do not wish to become a member.

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