Sign Up for Free Braille Books Program

To enroll in the Free Braille Books Program, please submit the following form below. Please email actionfund@actionfund.org or call 410-659-9315 with any questions.

First Name of Person Completing Form

Last Name of Person Completing Form

Phone

City

State

Are you a:

Parent/Guardian

Teacher/School Administrator

Librarian

First Name of Reader

Last Name of Reader

Birth Date

Parent First Name

Parent Last Name

Parent Email

Parent Phone

Name of Library

Shipping Name (Who should we mail the Free Braille Books to?)

Shipping Address (Where should we mail the Free Braille Books to?)

Shipping City

Shipping State

Shipping Zip