11% of survey complete.

Thank you for your interest in becoming an Oklahoma Supports partner.    Please complete the questions below.    Your information will be reviewed and you will be contacted in the near future.

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* 1. Organization's Name

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* 2. Organization's physical address  (if multiple addresses exist, use the home or corporate address)

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* 3. Organization's mailing address

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* 4. Organization's website address

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* 5. Your name

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* 6. Your title

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* 7. Your phone number

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* 8. Your email address

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* 9. Are you authorized to make decisions for this organization?

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* 10. If not, what is the name of the decision maker?

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* 11. Type

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* 12. Does this organization provide services to Oklahoma residents?

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