Opportunities for the Disabled

Disability Guide Booklet Order

 

Disability Guide booklet order form
  1. This form is for mailed copies of our Disability Resource Guide booklet(s)

  2. Date(*)
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  3. First Name (*)
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  4. Last Name (*)
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  5. Street Address
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  6. Address Line 2
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  7. City
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  8. State / Province / Region
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  9. Postal Zip Code
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  10. Country
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  11. Phone
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    (###)-###-#####
  12. Fax
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    (###)-###-#####
  13. Email(*)
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  14. Web Site
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  15. Multiple Choice




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  16. How many Guides do you like?
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  17. Where will you use the BC DRG?



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  18. Where will you use the BC DRG?



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  19. Would you be interestedin placing an ad or contributing content in the BC DRG ?


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  20. How did you know about the Disability resource guide?
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  21. Catpcha
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