Registration Form

Type of Submission:
New
Update

Agency Name:

Contact Name:

Address:

City:

State:

Country:

Zip:

Phone:

Fax:

E-Mail:

Web Address:

Type of Accessible Media (Braille, Large Print, Sound Recording, Braille Computer File, Electronic File,
NIMAS, Daisy, MP3. If Other, please explain.)

Type of agency (volunteer, nonprofit, state, government, commercial, individual small business)

Is your service limited to a certain state(s)? If so, which state(s)?

Type of distribution (check all that apply):
Loan
Free
Exchange of Materials
Sell

Check all that apply:

Certifications and Expertise:

I am Library of Congress Certified in Literary Format
I am CNIB Certified in Literary Format
I am NBA Certified as a Braille Textbook Transcriber
I transcribe Nemeth Code
I am Library of Congress Certified in Nemeth Code
I am CNIB Certified in Nemeth Code
I transcribe academic tests
I have Braille Computer Code Expertise
I transcribe Music
I am Library of Congress Certified in Music
I am CNIB Certified in Music
I create Tactile Graphics
I transcribe Foreign Language(s)
If so, which languages?
I am a Braille Transcription Instructor

Computer Software Use:

I transcribe using Computer Program(s)
If so, which programs?

Proofreading:

Proofreading is done using copyholders
Proofreading is done by someone other than the transcriber
I use Library of Congress Literary Certified Proofreaders
I use CNIB Literary Certified Proofreaders
I use Library of Congress Nemeth Certified Proofreaders
I use CNIB Nemeth Certified Proofreaders

Other Comments?