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ANCOR's Vision

Advancing excellence in supports and services ~ Leading the way to communities of choice.

ANCOR's Mission

To inform, educate and network service providers to safeguard, develop, grow and extend their capacity to support the choices of people with disabilities.

SELECT MEMBERSHIP CATEGORY (choose only ONE)
	Full Membership (Description \| 2008 Application)
	Associate Membership (Description \| 2008 Application)
	State Association Membership (Description \| 2008 Application)

AGENCY AND CONTACT INFORMATION (Please provide the requested information.)
Instructions: Please fill out the requested information. If your agency's information is pre-populated, please verify that the information displayed is correct. * Required fields are indicated with a red asterisk.

*Agency:
*CEO
*Address:
*City, State, Zip:
*Fax:	*Telephone:
Toll Free:	TDD Phone:
Web Site:
For purposes of voting in membership meetings please designate a primary contact:
*Primary Contact First Name:	*Last Name:
*Job title:
*Primary Contact E-mail:	It is imperative for ANCOR to have an email address in order for your agency to receive full benefits of ANCOR membership.

AFFILIATE AGENCIES AND CONTACT INFORMATION (Please provide the requested information if applicable.)
Instructions: Please download the one of the forms below, fill them out and FAX to: 703-535-7860 Attn: Joanna Cardinal. 1. MS Word 2. MS Excel

National Issues | Members Only | Benefits of Membership
Conferences, Education & Training | About ANCOR

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