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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal>Ohio,<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Below is the PAC Form 2018. I just sign-up a few of my members. Take the challenge and sign-up today. If you only can spare $10 per month, it would be greatly appreciated and will be used in a wonderful way. Whatever you can give, it will be to support the efforts of the National Federation of the Blind. Cleveland had 4 Kenneth Jernigan Scholarship recipients this year and others were from around the State of Ohio. That funding is supported by donors and contributions. So, consider and get on the PAK Plan today!<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>You can email your form.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>////<o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal>PAC Form 2018.pdf<o:p></o:p></p><p class=MsoNormal>NATIONAL FEDERATION OF THE BLIND <o:p></o:p></p><p class=MsoNormal>PRE-AUTHORIZED CONTRIBUTION <o:p></o:p></p><p class=MsoNormal>Current Status: r Active r Inactive r Increase or r Decrease $ ___________ per month <o:p></o:p></p><p class=MsoNormal>Welcome to the National Federation of the Blind’s Pre-Authorized Contribution (PAC) program. Your donation will help the blind live the lives they <o:p></o:p></p><p class=MsoNormal>want. By providing your financial information and signing this form, you are agreeing that once a month the National Federation of the Blind may <o:p></o:p></p><p class=MsoNormal>deduct the amount you specify from your checking account or charge your credit card the amount you indicate. All fields for your preferred <o:p></o:p></p><p class=MsoNormal>donation method and authorizing signature are required. <o:p></o:p></p><p class=MsoNormal>Bank Account Information: <o:p></o:p></p><p class=MsoNormal>Withdraw Date check one r 10th or r 20th <o:p></o:p></p><p class=MsoNormal>Account Holder _______________________________ <o:p></o:p></p><p class=MsoNormal>Amount to Withdraw $ _____________________________ <o:p></o:p></p><p class=MsoNormal>Bank Routing Number ___ ___ ___ - ___ ___ ___ - ___ ___ ___ <o:p></o:p></p><p class=MsoNormal>Checking Account Number _______________________________ <o:p></o:p></p><p class=MsoNormal>Bank Name _______________________________ <o:p></o:p></p><p class=MsoNormal>Credit / Debit Card Information: (Please print neatly.) <o:p></o:p></p><p class=MsoNormal>Withdraw Date check one r 10th or r 20th <o:p></o:p></p><p class=MsoNormal>Card Holder ____________________________________ <o:p></o:p></p><p class=MsoNormal>Billing Address ____________________________________ <o:p></o:p></p><p class=MsoNormal>City, State, Zip ____________________________________ <o:p></o:p></p><p class=MsoNormal>Amount to Charge $ ______________________________________ <o:p></o:p></p><p class=MsoNormal>Credit Card Number ____________________________________ <o:p></o:p></p><p class=MsoNormal>Expiration MM/YY _________________ <o:p></o:p></p><p class=MsoNormal>Mailing Address ____________________________________________________ City, State, Zip __________________________________________________ <o:p></o:p></p><p class=MsoNormal>Phone _______________________________________________________ Email ______________________________________________________________ <o:p></o:p></p><p class=MsoNormal>Signature _______________________________________________ Date ______________ <o:p></o:p></p><p class=MsoNormal>Return to: Treasurer, National Federation of the Blind, 1800 Johnson Street, Baltimore, MD 21230 Email: pac@nfb.org <o:p></o:p></p><p class=MsoNormal>LBP39P Rev. 6/18 <o:p></o:p></p><p class=MsoNormal>Tell us how you would like your PAC Plan recognized — name and state: (Please print neatly) <o:p></o:p></p><p class=MsoNormal>ID# PAC-____ ____ ____ ____ Name(s) _____________________________________________________________________ State _____________________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>