Member at Large Application

General Information
Member at Large Application
You can complete the on-line form on this page or you can download the following file to fill out and mail to the MCB office. MembershipForm.doc The following on-line form allows you to submit a Member at Large Application. If any entry errors are detected after you submit the form, the form will be reloaded and will include error messages describing the entry errors. Simply correct the errors described and resubmit the form.

Name:
Address:
City: State: Zip Code:
Telephone:
E-mail:
Occupation:
Age:
Vision:
Recommended by:
Reason for Joining:
Remarks:
The Missouri Chronicle
Each member is eligible to receive "The Missouri Chronicle", a quarterly publication providing news about the MCB and its members and activities. The Missouri Chronicle is avaliable on our web site moblind.org or it can be mailed to you in Braille, large print, or audio cassette tape.
Missouri Chronicle Delivery:
Application Submission
All applications must be accompanied by one year's dues of $10.00. Below you will find two buttons; the Print and Mail button and the Submit On-Line button. If you select the Print and Mail button, your computer’s printer dialog box will be activated so you can print out the application and mail it to the MCB office along with your check for the yearly dues. If you select the Submit On-Line button, your application will be electronically submitted to the MCB office and you will be transferred to the Pay Pal web site to pay the yearly dues using your credit card, debit card or Pay Pal account. Please Note: There is a convenience fee of approximately 3 percent added to payments made on-line.