Subscription/Donation Form

Subscription/Donation Form

SUBSCRIPTION/DONATION FORM

The VOICE OF THE DIABETIC is a quarterly magazine

published by the Diabetes Action Network of the National Federation of the Blind (NFB) for

anyone interested in diabetes, especially diabetics who are blind or are losing vision. An

outreach publication, it emphasizes good diabetes control, diet, and independence.

Donations are gladly accepted and appreciated.

Contributions are not only tax deductible but are needed to keep the VOICE and the

Diabetes Action Network moving forward to help people with all aspects of diabetes.

Members of the NFB Diabetes Action Network enjoy

priority services and unique benefits such as a continuous free subscription to the VOICE,

automatic access to committees covering all aspects of diabetes, free counseling

concerning all facets of blindness and diabetes, as well as access to diabetics who have

experienced complications.

The VOICE is free to any interested person upon

request. Each subscription costs the Diabetes Action Network approximately $20 per year.

To help defray publication expenses, members are invited, and nonmembers are encouraged,

to cover the subscription cost.

To begin receiving the VOICE, please check one:

[ ] I would like to become a member of the NFB

Diabetes Action Network and receive the VOICE OF THE DIABETIC. (Members are entitled to

special benefits.)

[ ] I would like to receive the VOICE OF THE

DIABETIC as a nonmember. (Nonmembers are encouraged to pay the institutional rate of

$20/one year; $35/two years; $50/three years.)

Send the VOICE in (check one):

[ ] print [ ] cassette tape for the blind [ ]

both

and physically handicapped

(recorded at slower-than-

standard speed of 15/16 IPS)

Optionally check this box:

[ ] I would like to make (or add) a

tax-deductible

contribution of $__________ to the Diabetes

Action

Network of the National Federation of the Blind.

PLEASE PRINT CLEARLY

Name:_____________________________________________________

Address:__________________________________________________

__________________________________________________

City:_______________________ State:______

Zip:__________

Telephone: ( )________________________

Send this form or a facsimile to:

Voice of the Diabetic

811 Cherry Street, Suite 309

Columbia, MO 65201

Telephone: (573) 875-8911

Fax: (573) 875-8902

Please make all checks payable to:

NATIONAL FEDERATION OF THE BLIND