NOTE: Due to U.S. Copyright law, RFB&D® does not offer distribution of RFB&D's DAISY CDs (AudioPlus®), Downloadable DAISY, or WMA Downloadable (AudioAccessSM) outside of the United States, except to U.S. citizens who are temporarily residing abroad. However, RFB&D has other options available to our international members. Please call Member Services at 609-452-0606 for details.
Complete ALL sections and be sure to include correct payment. Incomplete applications will be returned.
Please have the following certification completed by a qualified professional in the field of disability services, special education, medicine or psychology. The certifier must be a recognized expert who attests to the physical basis of the visual, perceptual or other disability that limits the applicant's use of standard print.
Appropriate certifying experts may differ from disability to disability. The following lists examples of professionals who are qualified to certify an applicant. It is no way a comprehensive list. If you have any questions about who is a qualified certifying professional, please visit www.rfbd.org/certification.htm or call Member Services at 800-221-4792.
If you are receiving services from Bookshare we will accept confirmed membership with Bookshare. Please check the box below and RFB&D will confirm your membership. If there is any problem with confirmation of your Bookshare membership, RFB&D's registrar will contact you.
If you are receiving services from The National Library Service for the Blind and Physically Handicapped (NLS) or its cooperating network libraries, we will accept a signature from one of their librarians in place of Option 1 to verify NLS readership.
As a National Library Services network librarian, I verify that the above mentioned individual is an eligible user of the National Library Service for the Blind and Physically Handicapped Talking Book Service.
Please read the statement below and sign at the bottom. Your membership application cannot be processed without a signature.
Membership Agreement An individual membership is valid for one (1) year. Your account will be permitted the customary 35 book limit.
Copyright Acknowledgement The contents of all RFB&D books are protected under copyright law. RFB&D strictly regulates the distribution of materials within a qualified member population that has provided documented evidence of a print disability. Copying, sharing or redistributing RFB&D books in any form to any person is strictly prohibited by law and is a violation of publishers’ right and the terms of your membership. Violators face a permanent suspension of RFB&D membership benefits and possible civil or criminal penalties.
Acceptance Under penalty of perjury (see 17 U.S.C. 506(a), 1201-1204 and 18 U.S.C. 1001, 2319, and related statutes), I understand the statement above and agree to all terms and conditions of RFB&D membership. I agree not to copy, share or redistribute RFB&D books in any form, to any person. I understand that to do so may result in permanent suspension of RFB&D membership benefits and possible civil or criminal penalties.
Cancellations and Refunds If you opt to cancel your membership and do not wish to keep any equipment you may have purchased, you must contact Member Services to request a Return Material Authorization (RMA) within 30 days of shipment of that equipment.
By signing, I agree to the terms of the copyright acknowledgment and agree to receive services, or, if I am a parent or guardian signing on behalf of a minor, agree for my child to receive services from RFB&D.
Applicant's Signature (or Parent/Guardian if applicant is under 18 years old) Print Name: Date:
If you submitted a paper application, please allow 7-10 days to receive your welcome letter and membership information that will include instructions for creating an on-line account.
Schools that have identified RFB&D's audiobooks as an appropriate accommodation for students eligible for services under federal disability legislation, including the Individuals with Disabilities Education Act (IDEA) and section 504 of the Rehabilitation Act of 1973, are required to provide free access to those books.
For more information on the rights of students with disabilities, visit the U.S. Department of Education, Office of Special Education and Rehabilitation Services at www.ed.gov. You may also call the U.S. Department of Education at 800-872-5327.
PLEASE SPECIFY WHICH TYPE OF MEMBERSHIP YOU ARE APPLYING FOR:
Student Individual Membership My school will pay for my membership (A Check or Purchase Order from the school in the amount of $100 must be attached, or credit card information in section 10 must be completed).
*Visit www.rfbd.org, Players and Accessories **MP3 players must have DRM Capabilities ***Windows Media Player 10 or higher
DAISY CDs are shipped Free Matter for the Blind & Other Physically Handicapped Persons which can take up to two weeks to arrive. See the UPS shipping rates in the Shipping section for other options.
Playing RFB&D's audiobooks requires special equipment. Visit www.rfbd.org and click on the "Players and Accessories" button to view our entire line of players. Note: Equipment is shipped UPS Ground
Equipment Total
Please provide a street address. UPS will not ship to a PO Box. For shipments to Alaska and Hawaii, please call Member Services at 800-221-4792.
Note: Membership, equipment and shipping prices are all subject to change without notice.
NOTE: All information on this application is considered confidential. RFB&D does not sell to, trade to, or otherwise share member information to any third parties; however, in conjunction with RFB&D's funding programs, aggregate data may be provided to agencies and institutions when needed for verification purposes or to illustrate the extent of services rendered.
Thank you for completing this membership application. We look forward to serving you!
20 Roszel Road, Princeton, New Jersey 08540 • 800-221-4792 • www.rfbd.org • Fax: 609-987-8116
© 2009 Recording for the Blind & Dyslexic, Incorporated. All Rights Reserved. Recording for the Blind & Dyslexic®, RFB&D®, AudioPlus®,Learning Through Listening®, AudioAccessSM, the Heart and Headphones design, and all trademarks and service marks are owned by Recording for the Blind & Dyslexic, Incorporated. Microsoft® Windows® Media, Windows XP® and Windows Vista TM are trademarks or Microsoft Corporation.
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