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Account Information

User IDs and passwords must be at least 6 valid characters.
Valid characters include letters, numbers, dashes, underscores and periods.
At least one symbol or punctuation character is required in password.
Do not include spaces in your User ID or password.
User IDs and passwords are case sensitive.
If you are certified with us, your user ID will be linked to your certification information within one business day.

User ID:

Password:

Confirm Password:

E-Mail Address:

Mailing Address and Phone

First Name:

Last Name:

Street Address:

Address 2:

Address 3:

City:

State or Province: (USA and Canada only)

Zip/Postal Code:

Country:

Primary Phone: (nnn-nnn-nnnn)

Alternate Phone: (nnn-nnn-nnnn)

Profile

Are you currently providing services to individuals who are blind or low vision? Yes No

Are you a professional in the vision loss field? Yes No

Are you a consumer who is blind or has low vision? Yes No

Current Profession:

Preferences

Would you like to receive general information from us and be on our mailing list? Yes No