Full name * Name change Email address Home phone Work phone Cell phone Preferred reading format Chapter/affiliate name or Member At Large Officer title (if applicable) Indicate if you are a member of any of the following listservs: California Council of the Blind discussion list (CCB-L), Presidents (CCB-Presidents), Blind Californian (BC), Membership (CCB-Membership) List the name of any CCB committees that you serve on (if applicable):