2021 Affiliate Report - Disability:IN

Submission Deadline: Tuesday, February 15, 2022.

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Tip: Download the following worksheet to collect necessary documents, make note of your answers, and use as a guide to complete your report submission. 2021 Affiliate Report Worksheet (DOCX)

2021 Affiliate Report Form

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2021 Affiliate Report

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Section 1: General Information

1. Affiliate name *

2. Website address *

3. Affiliate mailing address *

3. Affiliate mailing address

City

State/Province

Zip/Postal

4. Name and title of person completing this report *

5. Email address of person completing this report *

6. Are you the primary administrator of the Affiliate? *

Yes

7. Are you paid or volunteer? *

Paid

Volunteer

If you are human, leave this field blank.