Submission of this Membership Form is a two step process.
Step 1: Accurately complete all pertinent fields on the form and click the "Submit your membership form" button / link at the bottom for processing by our Treasurer.
Step 2: Click on the "Pay Now" button / link. When you do this you will be redirected to PayPal’s secure site for you to input and complete your payment. A PayPal account is not required. The easiest way to pay is with a credit or debit card. Be sure to follow PayPal’s instructions.
Some Specific PayPal Instructions: Once on the PayPal site you should enter your fee total in the "Dues Amount" box. For example: 10. No dollar sign, decimal or extra numbers are needed. Then click on the "Debit or Credit Card" button to pay with one of those.
Check Your Work: Please make sure to review this Membership Form for accuracy before you submit it to BACB. For example: Check your choices on any combo boxes to ensure you selected your intended options.
First Name (Required)
Last Name (Required)
Address (Line 1 of 2) (Required)
Address (Line 2 of 2)
City (Required)
State (Required)
Zip Code (Required)
Phone Number (Required)
Email (Required)
What Is Your Visual Acuity?BlindLow VisionFully Sighted
What Is Your Communication Format Preference?EmailLarge Print
Choose Your Dues$10.00 - Dues for 1 Year$24.00 - Discounted Dues for 3 Years
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