Register

To enroll in the Braille Books Program, please fill out the form below. Each applicant must be blind or low vision, and be a Braille reader. Please email [email protected] or call 410-659-9315 with any questions.

Note: All fields with an asterisk (*) are required.

Parent/Guardian/Personal Information

First Name

Last Name

Title

Organization Name

Address 1

Address 2

City

State

Zip

Phone

If the shipping address is different from the address provided above, please provide the shipping address.

Shipping Name

Shipping Address1

Shipping Address2

Shipping City

Shipping State

Shipping Zip

Please indicate your relationship to the participating child.

Participating Child Information

First Name

Last Name

Birth Date

Gender