Join the library form - Blind Low Vision NZ

1Membership type

2Contact details

3Register for a service

4Terms and conditions

Blind Foundation client status * Required
- I am a registered Blind Foundation client
- I am not a registered Blind Foundation client
Eligibility to join * Required
- I am a Blind Foundation client and/or a BLENNZ-enrolled student
- I am a New Zealand citizen/resident with a print disability
Age * Required
- I am over 18 years of age
- I am under 18 years of age

Name * Required
First name Last name
Blind Foundation client number
Parent/guardian’s name * Required
Address * Required
Street Address City ZIP / Postal Code Country
Phone * Required
Email * Required
Date of birth - must be mm/dd/yyyy format
MM slash DD slash YYYY
Gender
- Female
- Male
Resource Teacher Vision (RTV)’s name
First Last
School name (if applicable)
School address (if applicable)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Format preference/s
- Braille
- DAISY Audio
- Electronic Text
- Large Print

Conditions of service * Required
- I have read and accept the conditions of service. I will comply with the conditions of acceptance and access to the Library.
Conditions of service (parent/guardian to complete) * Required
- I have read and accept the conditions of service. I will ensure that my child complies with the conditions of acceptance and access to the Youth Library.
Comments
This field is for validation purposes and should be left unchanged.