APPLICATION FOR CALIFORNIA COUNCIL
OF THE BLIND
San Mateo County Chapter
Philip Kutner President
1128 Tanglewood Way
San Mateo, CA 94403
Tel. 650-349-6946
NAME______________________________________
ADDRESS__________________________________________
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LEGAL BLIND_____________ SIGHTED_________________
PHONE______________________________________________
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COMPUTER DISK_________ LARGE PRINT_____________
SIGNATURE________________________________________
ANNUAL DUES$15 (FIFTEEN DOLLARS)___________________