OPVIC Supporter Form

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All information is kept strictly confidential

Email *

Full Name *

Street *

Apartment Number

City *

Province/State *

Country *

Postal/Zip Code *

Phone number

Are you a resident of Ontario? *

Yes

Are you the parent, guardian or family member of a child, youth or adult who is blind, deafblind or low vision? *

Yes

If you have a child with vision loss in an elementary or secondary school in Ontario, which school board are they in?

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