Pine Tree Guide Dog Users Registration

Thank you for your interest in joining or renewing your membership with PTGDU. Please provide the information below.

Note to screen reader users: In order to navigate this form and hear all the questions (especially those with radio buttons), it may be necessary to exit Forms Mode.

Price: $20 for access until December 31, 2023

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Primary Phone Number with Area Code

Secondary Phone Number with Area Code

Email Address *

Is this a new registration or a renewal? *NewRenewal

Are you, or have you ever been, a guide dog handler? *YesNo

To comply with postal regulations when we send you items via the U.S. Postal Service, we need information concerning your degree of visual impairment (we are allowed to use) *Blind or Legally BlindVisually ImpairedFully Sighted

As a member of GDUI, you are entitled to receive copies of the magazine, “Paws for News You Can Use” via e-mail. Please indicate if you would like to receive this publication.YesNo

As a member of ACB, you are entitled to receive ACB's magazine the Braille Forum. If you are not currently receiving the Braille Forum, or wish to change the format in which you receive it, please check one of the following.EmailBrailleLarge Print

You can pay with PayPal, credit or debit card, or by check. Please indicate which method you will use. When you click the SIGN UP NOW button, you will be redirected to a payment page. Thank you!PayPalCredit CardDebit CardCheck (You will be shown the mailing address.)

Other Personal Information

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