Your Contact Information
Vermont Association of the Deaf census form for Deaf, DeafBlind, and Hard of Hearing Vermonters

--->  if you don't remember your email or don't have email, type vtad.secretary@gmail.com <---
Email *
your LAST name *
Your FIRST name *
your STREET ADDRESS *
CITY / TOWN where you live *
STATE where you live *
your ZIP CODE *
Vermont COUNTY where you live *
This question for Vermont residents.  if you are not Vermont resident, please choose "Not Vermont resident"
your VP NUMBER *
--->  if you don't have one or don't remember, type 123-000-9999  <---
your TEXT NUMBER *
--->  if you don't have one or don't remember, type 123-000-9999  <---
your AGE DEMOGRAPHIC / GROUP *
your IDENTITY *
How do you want to get information from Vermont Association of the Deaf -- legislative updates, upcoming meetings, social events, etc?
--->  please choose one option that works best for you  <---
CONTACT me by... *
Do you know another Deaf / DeafBlind / Hard of Hearing person who lives near you? *
This question is for Vermont residents.  if you are not Vermont resident, please select NO except if you know Deaf / DeafBlind / Hard of Hearing people who live in Vermont
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