Friends of Application

• Name
• E-mail Address
• Phone Number
• Home Address
• Date of Birth (optional)
• Place of Business
• Business Phone Number
• May we call you at work? Yes No


• How did you hear about the "Friends of" the ILCNSCA?
• Have you had any previous experience with people with disabilities? Yes No


• If yes, how?
• Please list special skills and interests
• Availability - Days and hours that you are available
• Specific Area of Interest Public Speaking
  Public Relations
  Grant Writing
  


• Reason for wanting to be involved with "Friends of" the ILCNSCA
• List other agencies, organizations, or clubs with which you are affiliated