Membership

Braille Zoomers - Starter Kits - Application Form

Contact Information

First name *

Last name *

E-mail address *

Address (line 1) *

Address (line 2)

City *

Province *

Postal code *

Telephone

Demographics

What is your current age (in years)? *

Braille Learning

At what age did you start learning braille? *

Which braille codes are you currently learning? (Check all that apply.)

Uncontracted English

Contracted English

Uncontracted French

Contracted French

Unknown / I do not know

Where are you learning braille (for example, a self-paced distance course, a rehabilitation centre, etc.)?

Why are you learning braille? (for example, to read novels, recipes, labels, phone numbers, etc.)?

Do you use standard size or jumbo size braille? *

Standard

Jumbo

Unsure/don't know

Do you currently own a slate and stylus? *

Yes

Do you currently own a Dymo braille labelling device? *

Yes

Do you participate in the Braille Zoomers monthly virtual peer-support program? *

Yes

No, but I would like to join or learn more

Any additional comments? (optional)