Organization and Site Administrator Information
After watching the video, please enter your organization and site administrator information. The site administrator is the person who coordinates OBB activities at an organization, and should be the same person filling out this form.
Organization Name: *
Your answer
Organization Address: *
Your answer
Site Administrator's Name: *
Your answer
Site Administrator's Email: *
Your answer
Site Administrator's Phone Number: *
Your answer
Is your organization already an Ohio Benefit Bank site? *
How did you hear about us? *
Your answer
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