The National Broadcast Reading Service Inc.

Membership Form

The National Broadcast Reading Service Inc. (“NBRS”) is a multi-media non-profit registered charity whose vision and mission is reduce barriers to media faced by an estimated 5 million vision- and print-restricted Canadians.

I warrant that I am a Canadian citizen and that I am 18 years of age or older and wish to pay the membership fee and to become a Member of the Corporation for the balance of this calendar year and enjoy all the rights of membership.

I understand that I am entitled to notice of meetings of Members and to vote at all such meetings as well as to receive reports regarding the business to be conducted at such meetings. I further understand that if I choose to appoint someone as my nominee to vote for me at any such meeting, there is a form and a process to follow under the bylaw.

I also understand that under the PIPEDA (Personal Information Protection and Electronic Documents Act) terms NBRS will not make public the names of its members without the prior written approval of the individual member(s) concerned. NBRS neither buys subscription lists nor sells its lists.

Dated: ________________________ Member: _______________________

(Mark your selctions below)

___ $15 Membership fee enclosed

Payment: ___Visa ___MasterCard ___Cheque ___Cash

Card No.: ____________________________________________

Expiry Date: ___________________

Signature: ___________________________________________

Today's Date: __________________

___ Donation

Yes I would like to make monthly donations. Please withdraw from:

___Visa ___MasterCard

OR Deduct specified amount from the account number on the blank cheque marked “VOID”

___ Please keep me informed

On behalf of the NBRS Board, Staff, more than 800 Volunteers and 5 million Canadians...we Thank You for your support!

Mail to:

The National Broadcast Reading Service Inc.
Attn: Corona Henderson
303-1090 Don Mills Rd.,
Toronto, ON M3C 3R6
Canada

Phone: (416) 422-4222 ext. 236
Toll-Free: 1-800-567-6755 ext. 236
Fax: (416) 422-1633
www.nbrscanada.com
chenderson@nbrscanada.com