COALITION JOIN FORM
The Disability Action Coalition is
a coalition of Disability Organizations that
serve and/or advocate for and with people with
all types of disabilities and their families.
“It Takes a Community”
For more information or to join online:
(916) 325-1690 or (916)325-1695 TTY
www.disabilityactioncoalition.org
California Foundation for Independent Living Centers
1234 H Street, Suite 150
Sacramento, CA 95630
(916) 325-1690
REGISTRATION TO JOIN THE DISABILITY ACTION COALITION
* Required information
*Organization Name: ____________________________________
*First Name: ___________________________________________
*Last Name: ___________________________________________
Job Title: (optional) _____________________________________
Organization Website: (optional) __________________________
*Address Line One: ______________________________________
Address Line Two: ______________________________________
*City:____________________ *State:_______ *Zip Code:_______
*Primary Contacts Email: _________________________________
Secondary Contacts Email: _______________________________
Preferred email format: (circle one)
HTML
Text
Office Phone: _________________________________________
Cell Phone: ___________________________________________
Fax: _________________________________________________
 Yes! My organization plans to assist in the planning and organizing of
the Disability Capitol Action Day. Please add my organizations name to
the list of partners on the DAC website.
 Yes! My organization will be mobilizing people to Disability Capitol
Action Day.
 Yes! My organization represents and serves people with disabilities.