Sign-up

Membership Type *	The Blind Online Success System Introductory Level Membership (free) Sign up to create your account now!
Payment System *	Free Signup Totally free
Your Name * Your First & Last name	Enter your first name in text input box number 1 and last name in box 2. These fields are required
Your E-Mail Address * A confirmation email will be sent to you at this address	Enter you email address in text input box. This field is required
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	Enter your login name in text input box. This field is required. check for uniqueness
Choose a Password * Must be 4 or more characters	Enter your password in password input box. This field is required.
Confirm your password * Enter password again	Enter your password again in password input box. This field is required.
Home Phone Number * Enter your home phone number in text input box. If you only have a cell phone and no home phone, please enter your cell number. This field is required.
Work Phone Number Enter your work home phone number in text input box. This field is optional.
Cell Phone Number Enter your cell phone number in text input box . This field is optional.
Best Time and Number to Call You * Enter the best time and number to reach you in text input area. This field is required.
State or Country * Enter your state or country in the text input box. This field is required.
How did you hear about BOSS Explain how you discovered the BOSS program in the text input box. This field is optional.
Adaptive Software Usage * Enter the adaptive software you currently use in the text input box. This field is required.
Additional Information Please provide any additional information regarding your background, skills or computer skills that you would like us to know. Type it in the text input box. This field is optional.
Agreement By submitting this application I certify that I am blind or visually impaired. I have reasonable computer skills. I can use adaptive software such as a screen reader or large print magnification program. I have access to the internet and can surf the internet. I can send and receive email communications. I understand there are no income guarantees. I am willing to assist as an apprentice in exchange for the free coaching and training. I do not need to currently have the skills to do this and will assist as I learn through the program. I understand that I will have 60 days to review the introductory materials and ask questions. Within 60 days I will have reviewed the introductory materials and if I desire to continue in the program I will contact Lori or Jeff to request an upgraded membership.	By Checking the box you agree!