COLORADO CROSS- DISABILITY COALITION -MEMBERSHIP FORM
Colorado Cross-Disability Coalition | Join CCDC!!
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CCDC Membership Form
Please fill this out to become a Member of Colorado -Cross-Disability Coalition (CCDC). There is no membership fee and you will receive updates and alerts on laws and policies affecting civil rights for the disability community, as well as notices regarding activities, and other great stuff!* Questions about membership can be directed to email@example.com.
* What is your first name?
* What is your last name?
Date of Birth
Please enter the first and last name of other family members here (Optional):
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* Do you want to subscribe to the email alerts list? (This requires an email address)
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What is your email address? (Optional)
You must select each topic if you wish to get alerts/information about that issue.
Health Care Access-General
Medicaid -Long Term Services (e.g. HCBS)
Social Justice/Civil Rights/Access to Justice
What is your mailing address? (If applicable)
Address Line 1
Address Line 2
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District of Columbia
What is the best phone number to reach you at?
Do you want to be contacted to volunteer?
Home Phone (Optional)
Cell Phone (Optional)
* By checking this box you acknowledge that you would like to become a free member of the Colorado Cross-Disability Coalition