Agency Registration

Agency Registration

Developmental Disability Awareness Fair Participant Registration

Please register before March 5, 2012. All confirmations and further information will be emailed to registered applicants. Thank you for your participation. We are excited for our 2012 FAIR!

Agency/Company Name*
Name of Contact Person*
Address or PO Box*
Street AddressCityZip Code
Phone*
Ext.
Email of Contact Person*
Website
Check box if you will provide a door prize.*
- Providing Door Prize
- Unable to Provide Door Prize
Do you require an outlet?*
- YES
- NO
Reminder: If you require an outlet please bring an extension cord.

Developmental Disability Awareness Fair Participant Registration

Employee Login