MNCCD 2024 Membership Form


The Minnesota Consortium for Citizens with Disabilities (MNCCD) is a broad based coalition of advocates working to change public policy to create a more equitable society for people who have disabilities. MNCCD does this work by building awareness, providing education, and engaging the community.

Organizations that support and/or advocate with people who have disabilities, their family members, and allies are invited to join MNCCD if they share our mission, vision, and values.
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First and Last Name of Primary Contact *
Email *
Title *
Organization *
Organization Address *
Organization Website *
First and Last Name of Secondary Contact *
Email of Secondary Contact *

My organization’s primary service area, and/or most active policy advocacy issue area (check all that apply):

 *
Required
MN Legislative Districts where your organization has a presence (provides services, works with individuals and families, etc.) To find your district information, follow the link: https://www.gis.leg.mn/iMaps/districts/ *

Does your organization have a dedicated department or staff member serving in a legislative relations and/or policy advocacy capacity? If yes, we would like to invite that individual (or individual of your choice) to participate on our Policy Committee. Please provide their name, title, and email. 

Does your organization have a department or staff member serving in a grassroots capacity? If yes, we would like to invite that individual (or individual of your choice) to participate on our Grassroots Committee. Please provide their name, title, and email. 

Does your organization have a department or staff member working in communications? If yes, we would like to invite that individual (or individual of your choice) to participate on our Communications Committee. Please provide their name, title, and email. 

Does your organization have a department or staff member involved in diversity, equity, and inclusion? If yes, we would like to invite that individual (or individual of your choice) to participate on our Anti-Discrimination and Intersectionality Committee. Please provide their name, title, and email. 

Who is the designated voter from your organization for full membership votes? (Name and Email)  *
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