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Minnesota DeafBlind Association
ATTN: Membership
1821 University Ave. W., Suite S-117
St. Paul, MN 55104
Name: ____________________________________________
Address: __________________________________________
City: _____________________________________________
State: ________ Zip Code: ___________________________
Phone: ___________________________ V -- TTY-- BOTH
E-mail: ___________________________________________
MDBA Newsletter/flyers format:
Note: due to mailing costs, if you have email, you will receive the newsletter
that way.
__ Email (address: ___________________________________________)
__ Large print
__ Braille
As a member of MDBA, you are expected to volunteer
your time and energy to support MDBA activities. Which committees are
you interested in?
__ Helen Keller picnic (spring/early summer)
__ Thanksgiving banquet (fall)
__ Holiday party (late fall/early winter)
__ Elections (winter for Jan. member mtg)
__ Fundraising
Can we put your name, address, phone number,
or E-mail address into the MDBA address book? MDBA
Address Book will be shared only to MDBA members, not to other organizations.
__ yes __ no
Membership Dues:
__ Member - $15.00/year
__ Sponsor - $30.00/year
Gifts and donations of all sizes are appreciated:
$ _______
Total amount due:
$ _______
Thank You!
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