Disability Action Coalition Membership Form
Thank you for your interest in the Disability Action Coalition! The following information is strictly for our internal use only and will not be shared aside from DAC business without your consent (Exception: If you select "Yes" to being a media key contact, we will share your preferred method of contact with press, but never without prior notification).

Note: If you have any difficulty using this form, received this form in error, or are unsure why you may have received it, please contact us: CaliforniaDAC.info@gmail.com

Thanks! -DAC Executive Committee
Email address *
First Name *
Last Name *
Gender Pronouns
Phone Number (Please include Area Code) *
Are you representing an organization? *
Is this your first time joining the Disability Action Coalition (DAC)? *
Have you attended Disability Capitol Action Day (DCAD) before? *
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