<*** Beginning of form ***> Organizations FOR The Blind. New Listing Form. Use this form to submit information about your organization for possible inclusion in our list of Organizations FOR The Blind. Items marked with an (*) are required; your organization will NOT be listed if any of the required information is not provided. The rest of the items are recommended but optional. Please provide your name and E-Mail address so we can contact you if needed. If you'd like you can choose a password which you will then be required to use any time you update your organization's listing. The password is an extra precaution but is not a guarantee of security. * Do you work for this organization? ___Yes - I work for this organization. ___No - I don't work for this organization. * Contact's Name: __________ * Contact's E-Mail: __________ Password: __________ Organization Web Site URL: http://_________________________ * Organization Name: __________ Suite #: * Organization Street Address: P. O. Box: __________ * City: __________ * State: __________ * Zip Code: __________ * Country: __________ * Voice - Phone: (___)___-____ TDD - Phone: (___)___-____ TOLL FREE - Phone: (___)___-____ FAX - Phone: (___)___-____ E-Mail You can list up to 5 E-Mail addresses. You can also provide a description or person's name for each of the 5 E-Mail addresses. E-Mail: Name or description - name@organization.com E-Mail 1: E-Mail 2: E-Mail 3: E-Mail 4: E-Mail 5: Organization Description. Your organization description must meet the following requirements and may be edited for length and/or clarity. 1. Be no more than 75 words. 2. Should only describe the products available and avoid hyperbole. (Like the plague ... or was that cliches. :) ) Organization Publications. List the publication(s) produced by your organization ; catalogues, brochures, magazines, newspapers, etc. Include the name and how often each is published. Please put one publication per line or separate multiple items with a blank line. This list is not intended for listing articles published by individuals or organizations in journals, magazines, newspapers or other periodicals. 1. 2. 3. 4. 5. Type of services provided. Choose all that apply. ___ Rehabilitation Center - teaching mobility, living, and other skills. ___ Residential School - complete education courses. ___ Guide Dog School - Training guide dog teams. ___ Other - please specify. _________________________ Comments: <*** End of form ***>