Membership Form

ACB Diabetics in Action 2026 Membership Form

Thank you for your interest in the special interest affiliate of the American Council of the Blind that focuses on advocating for those who are blind and visually impaired that may have diabetes or who have family members with diabetes. We will be asking you for a number of pieces of information that we need to collect for your membership application. You will then be able to pay for your membership after completing the form which will enroll you for the 2026 membership year. Again, thank you so much for your interest.

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Step 1 of 6

Personal Information

In this section we will ask for your contact information for the membership form.
Name*
Enter the email address you would like on your membership record.
Enter the home phone number you would like used on your membership record.
Enter the cell phone number you would like used on your membership record.
Address*
Enter the address you would like to use on your membership record. At times we may mail you items of interest.
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