Ohio Disability Vote Coalition

Join ODVC today!

• _____________________________________________
  Name of Organization
• _____________________________________________
  Name of ODVC designee

• ________________________________________
  Date

will participate as a member of the Ohio Disability Cote Coalition. As a member, we will adopt the mission of ODVC, work on established priorities, and commit to following the ODVC structure.

Check at lease one: Our organization will contribute at least $50 toward expenses
incurred by ODVC to accomplish its priorities.
Our organization will contribute in-kind services.

• _____________________________________________
  Authorized Signature
• _____________________________________________
  Address
• _____________________________________________
  City/zip

• ________________________________________
  Title
• ________________________________________
  Phone
• ________________________________________
  E-mail

To become an ODVC member, complete this form and mail to:
ODVC
670 Morrison Road, Suite 200
Gahanna, OH 43230-5324

Questions? Call (866) 575-8055