HUMAN SERVICES ADVISORY COUNCIL, INC
P.O. Box 894 Council Bluffs, Iowa 51502
CB Helps Agency Form
This form is used to register new CB Helps agencies with HSAC or CB Helps.
Organization Name *
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Description in 30 words *
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Address
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Organization Phone Number *
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Organization Email Address *
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Website Address
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Contact Person's Name *
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Contact Person's Email Address *
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Contact Person's Phone Number *
Your answer
Services Your Organization Provide (tick all that apply) *
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