[Greater-baltimore] FW: BISM Workshop for Seniors
National Federation of the Blind of Maryland
nfbmd at riccobono.us
Thu Sep 13 14:06:38 UTC 2012
This sounds like a fantastic opportunity. As many seniors do not have email,
please consider calling seniors in your life with this valuable information.
Melissa
-----Original Message-----
From: Mollyne Honor [mailto:mrhonor at LBPH.LIB.MD.US]
Sent: Wednesday, September 12, 2012 11:28 AM
To: LBPH_INFO-L at LISTSRV.MSDE.STATE.MD.US
Subject: BISM Workshop for Seniors
HURRY -- DON'T MISS OUT!
LIFE ENHANCEMENT WORKSHOP
for
Senior Citizens with Significant Vision Loss (pre-registration required)
WHAT: FINAL WORKSHOP OF THIS GRANT YEAR
WHERE: BLIND INDUSTRIES & SERVICES OF MD (BISM)
3345 Washington Boulevard
Baltimore, MD 21227
WHEN: September 27, 2012 - Thursday
10 am to 2:30 pm
INCLUDES: Demonstrations and Hands-on Instruction
. Techniques for Independence
. Aids, Appliances & Talking Devices
. Technology & Computer Demos
. Independent Living Skills
. Intro to Braille & Communication
. Travel Skills
. Resource Packet for Every Participant
. LUNCH ALSO INCLUDED!
... ALL AT NO COST
For application or further information, please contact:
ANDY McIVER, amciver at bism.org, 410-737-2648
Registration limited - Please apply asap
Proudly Sponsored by:
Blind Industries and Services of Maryland (BISM COMPASS LOGO) with funding
and support from MSDE - DORS/OBVS
Workshop Location:
BISM-Baltimore
Workshop Date:
Sept. 27, 2012
Description: A_New_Black_Logo
Blind Industries and Services of Maryland
Life Enhancement Workshop
WORKSHOP APPLICATION
Part I
Applicant Information
Name:
Telephone:
Address:
Cell Phone:
E-Mail:
Date of Birth:
County:
Referred By:
Agency:
I am diabetic: YES[ ] NO[ ]
I am visually impaired: YES[ ] NO[ ]
Visual Acuity: Right Eye_________ Left Eye __________
Medical Restrictions (diet, activity, etc.):
Other Disabilities:
Medications:
Allergies:
I am a Veteran: YES[ ] NO[ ]
Emergency Contact
Name:
Relationship:
Telephone (H):
Telephone (other):
Address:
Physician Information
Doctor's Name:
Telephone:
Address:
1. I understand that I am responsible for my own transportation to and
from the workshop.
2. I understand that BISM is not responsible for providing health
insurance or health care for me while I am participating in this program. I
assume sole responsibility for my health insurance and all medical expenses.
3. I understand that pictures or videos may be taken during training
time for rehabilitation department photo
albums and/or BISM public relations purposes.
4. I will not hold Blind Industries and Services of Maryland liable for
injuries and damages as a result of
participation in this program.
____________________________________________
____________________
Signature
Date
**For Staff Use Only**
Application reviewed. All sections complete.
Staff Initials: ______Date: ______
LOCAL BISM CONTACT:
Baltimore, MD
Andy McIver amciver at bism.org 410-737-2648 888-322-4567
Description: A_New_Black_Logo
BLIND INDUSTRIES and SERVICES of MARYLAND
WORKSHOP APPLICATION
Part II
Name: _____________________________________
Age:
55-59 95-99
60-64 100 & over
65-69
70-74
75-79
80-84
85-89
90-94
Gender: Male Female
Race/Ethnicity:
Hispanic/Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Two or more races (not Hispanic/Latino)
Unknown (only if consumer refuses to identify)
Degree of Visual Impairment:
Totally Blind (LP or NLP)
Legally Blind (excluding totally blind)
Severe Visual Impairment
Major Cause of Visual Impairment:
Macular Degeneration
Diabetic Retinopathy
Glaucoma
Cataracts
Other
Other Age-Related Impairments:
Hearing Impairment
Diabetes
Cardiovascular Disease and Stroke
Cancer
Bone, Muscle, Skin, Joint, and Movement Disorders
Alzheimer's Disease/Cognitive Impairment
Depression/Mood Disorder
Other Major Geriatric Concerns
9.19.12 scr
Type of Living Arrangement:
Lives Alone
Live with Others (family, spouse, caretaker, etc.)
Type of Residence:
Private Residence (house or apartment)
Senior Living/Retirement Community
Assisted Living Facility
Nursing Home/Long Term Care Facility
Source of Referral:
Eye Care Provider (ophthalmologist, optometrist)
Physician/Medical Provider
State VR Agency
Government or Social Service Agency
Senior Program
Faith-Based Organization
Independent Living Center
Family Member or Friend
Self-Referral
Veterans Administration
Other
www.bism.org
________________________________
No virus found in this message.
Checked by AVG - www.avg.com
Version: 10.0.1424 / Virus Database: 2437/5264 - Release Date: 09/12/12
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.emz
Type: application/octet-stream
Size: 3482 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image002.png
Type: image/png
Size: 2144 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment.png>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image003.jpg
Type: image/jpeg
Size: 20303 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image004.jpg
Type: image/jpeg
Size: 4351 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0001.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image005.png
Type: image/png
Size: 193 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0001.png>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image006.emz
Type: application/octet-stream
Size: 3164 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0001.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image007.png
Type: image/png
Size: 2046 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0002.png>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image008.emz
Type: application/octet-stream
Size: 5507 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0002.obj>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image009.png
Type: image/png
Size: 4182 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0003.png>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image010.jpg
Type: image/jpeg
Size: 4351 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0002.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image011.png
Type: image/png
Size: 160 bytes
Desc: not available
URL: <http://nfbnet.org/pipermail/greater-baltimore_nfbnet.org/attachments/20120913/77a82a49/attachment-0004.png>
More information about the Greater-Baltimore
mailing list