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EAEDC Campaign Organizational Endorsement Form
Campaign to Strengthen Assistance for Participants of the Emergency Aid to the Elderly, Disabled, and Children (EAEDC) Program
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Organizational Endorsement
*
Will your organization be endorsing the EAEDC campaign? Endorsers will be listed on campaign materials, receive campaign updates, and participate in advocacy activities.
Yes
Not at this time, but we would like more information
No
Name of Organization/Agency
*
Your answer
Organizational Contact: First Name
*
Your answer
Organizational Contact: Last Name
*
Your answer
Contact's Title
Your answer
Email Address
*
Your answer
Phone Number(s)
*
Your answer
Organizational Street Address
Your answer
City/Town
Your answer
State
Your answer
Zip Code
Your answer
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