Membership Form

Mountain State Council of the Blind, Inc.
P. O Box 4006, Morgantown, WV 26504
www.mscbwv.org

2017 Membership Form

In order to update our records, it is important to return a completed form, making sure to fill in the format preferences and visual status for each person.

Please make extra copies to share with others.

Choose one of two ways:

Use the below online form and pay via PayPal. Please share the link of this online form with others.
Download the Membership Form below, print, complete, and make check or money order payable to MSCB. Return it with appropriate dues to Ninetta Garner, MSCB Treasurer, PO Box 4006, Morgantown, WV 26504, or email to Treasurer@mscbwv.org..

Payment for any category of membership should include this completed form, dues and any donations.

Call Kevin Maynus, MSCB President, at 304-222-1807 or Ninetta Garner at 304-381-2729 for more information.

MSCB Membership Form 2017

Online Membership Form

Member information

Member Status (required) *

First and Last name (required) *

Street address (required) *

Address line 2

City (required) *

State (required) *

Zip (required) *

County *

Primary Phone (required) *

Mobile phone

Email (required) *

PREFERRED FORMAT for MSCB newsletter and information:

ACB Braille Forum magazine preferred format: (required) *

Visual Status (required): I am *

Dues and Donations

Please select one membership category that applies:

Chapter Dues, which includes chapter, state & national. (Specify which chapter.)

Potomac Valley chapter (Romney and area) $15.

Tri-County chapter (Eastern Panhandle area) $15.

Vandalia chapter (Morgantown and area) $15.

MSCB Member-at-large Dues for only state and national:

State & National Dues: $10.00 ___

Special Memberships:

MSCB Junior Member (ages 12 to 17) $5.00

Supporting Member (Minimum $10.00)

Special Memberships: Supporting Member (Minimum $10.00)

MSCB-Only Lifetime Member Dues

$200.00

For national and or chapter dues, add additional $5.00 for each.

MSCB-Only Lifetime Member Dues For national and or chapter dues, add additional $5.00 for each.

Donations (Please specify):

MSCB is an IRS 501(c)(3) nonprofit organization. Donations are tax deductible.

I'd like to donate to Anna L. Hunt Memorial Academic Scholarship (please specify amount) $

I'd like to donate to Barbara Fierst Memorial Technology Grant (please specify amount) $

I'd like to donate to the MSCB General Fund (please specify amount) $

Payment

When you hit the "Continue" button you can mail your payment or pay online. If paying through PayPal, add an additional $1.00 for each item.(required) *

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