InTouch Networks

Registration for InTouch Networks^SM Over the Internet


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In order to receive this service, we must be able to determine under the U.S. Copyright laws that you are unable to read normal printed material. May we contact a competent authority to verify your inability to read normal printed material? * Yes No

If no, we will be unable to provide this service to you. If you would like to talk with someone, please call 1-800-456-3166 or 212-769-6270.

Please indicate the vision and/or physical problem(s) that makes you unable to read normal printed material: * Check all that apply	Glaucoma
	Cataracts
	Diabetic Retinopathy
	Macular Degeneration
	Other Vision Problem (Please describe)
	Physical Disability (Please describe)
How long have you had this vision and/or physical problem?
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