Ogden Association of the Blind Application for Membership

First name

Last name

Address

Phone

Birthday

Month

Day

Year

Select One Option Below

Totally Blind

Legally Blind (Visual acuity no more than 20/200 or visual field subtends an angle no more than 20º in best eye with best correction)

Visually Impaired (Visual acuity no more than 20/70 or visual field subtends an angle no more than 20̊ in best eye with best correction)

Sighted

Please Add Two References (not related to you):

Reference Name

Phone Number

Reference Name

Phone Number

What are your reasons for wanting to join the OAB?

How did you hear about the OAB

Message to the board

Your application will be voted on at the next OAB Board meeting. If

you are approved, you will be voted on at the next general meeting.

You should be in attendance. Applications should be submitted to

the membership chairman with one year’s dues ($20).

Pay at this link, bring to a meeting, or mail to:

OAB

P.O. Box 150032

Ogden, UT 84415.

If you have any questions, call Bill or Sandy Gibson at:

(801) 732-8900