SELF-ADVOCATES GROUP APPLICATION
Name of Self-Advocate Group:
Advisor’s Name:
Advisor's Contact Information: __________________________________________________________________________
Address, City, State Zip
____________________________________________ _________________________________________________
Area Code / Phone Number Email
Address of Meeting Place:
Officers of Self-Advocates Group
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Officer |
Name |
Address, City, State Zip |
Area Code / Phone Number |
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President |
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Vice President |
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Secretary |
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Treasurer |
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Members of Self-Advocates Group
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Members |
Name |
Address, City, State Zip |
Area Code / |
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Mail or fax application to:
Nanette Whightsel
Director Family Education and Community Resources
The Arc of Indiana
107 N. Pennsylvania Street, Suite 300
Indianapolis, IN 46204
317-977-2385 (fax)