Personal Information


Please note: This registration form must be completed by a parent/guardian.

Fill out the information below, then click Next to continue.


Intended Audience:
This program is for Michigan families of children, ages 0-9, who are blind or low vision and/or deaf or hard of hearing.

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Does this intended audience describe you?

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Registration Type:

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Would you like to be added to our email list to receive news and updates? (Please select all that apply)

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