Voice Subscription Form

Voice Subscription 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 and physically handicapped
(recorded at slower-than-standard speed of 15/16 IPS)
[ ] both

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
1412 I-70 Drive SW, Suite C,
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8911

Please make all checks payable to: NATIONAL FEDERATION OF THE BLIND