Page Title

TAPVI

Texas Association for Parents of
Children with Visual Impairments

Membership:

Application for Membership

I would like to join TAPVI and NAPVI.

Enclosed are my dues of   $_______________,

and a Donation of              $_______________,

for a Total of                      $_______________

Please check all that apply:

____ Parent / Grandparent / Guardian Membership, $40.
____ Professional Associate Membership, $50
____ Group / Agency Membership $250
____ Request a Partial / Full Scholarship

Name: __________________________________________

Mailing Address:
________________________________________________

________________________________________________

Telephone Numbers:

Home: (    )_______________________________________

Other: (    )_______________________________________

E-Mail __________________________________________

Names of Children, their Birthdays & Eye Condition

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Signature and Date:

________________________________________________

             TAPVI
             C/O
             TSBVI Outreach Program
             1100 West 45th. Street
             Austin, Texas 78756

Print this page.
Fill out the application and mail it to:

* * *

Dues:
Dues are combined with NAPVI.
NAPVI dues* are $40 per family per year.
Members of NAPVI receive the Awareness Newsletter and
become members of TAPVI which receives $15 of the dues.

* A limited number of scholarships are available for families.
  Please indicate if you need assistance with dues.