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Community Support Request
Date of Request:
Name of Organization:
Organization Contact Name:
Contact Phone Number:
Contact Email:
What's the nature of your request?
How soon do you need a reply from us?
Are you a non-profit organization?
Yes
No If yes, please provide ID#
How many deaf/hard of hearing attendees or interpreter attendees do you anticipate will attend?
What is your organization's mission?
What services do you provide for the deaf and hard of hearing?
If this request is for a particular event, what is the purpose of the event?
What U.S. states will be represented by your attendees?
How will our contribution be used?
What other VRS companies are contributing?
How will we be recognized for our contribution?
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