Welcome to DACnet! We are very pleased that you have decided to take advantage of this new service and we look forward to providing you with the latest information and news related to disability rights and issues! To get started, follow the instructions below. All of the fields are optional except for your email address. Please be assured that any information you provide will be kept completely cnofidential. For more information on privacy, please view our privacy policy. And remember, you can cancel at any time by simply contacting us via phone, postal mail, or email, or feel free to stop by any of our offices in person. Your E-Mail Address: (The only required field.)     What subjects would you like to be informed of? General News Political Action Alerts Disability Rights Advocacy The DAC Electronic Newsletter Assistive Technology The DAC Printed Newsletter Would you like to receive only information pertaining to a specific geographic region? No, keep me informed of news from all areas Yes, please keep me informed of news pertaining only to the following geographic region(s) serviced by DAC: Moscow Couer d'Alene Lewiston     OPTIONAL: If you would like to be contacted by phone or postal mail, or if you would like to receive our printed newsletter, please provide us with some additional information. Otherwise, skip to Step 5. First Name:   Last Name: Street Address City: State: Zip: Phone: - -   Alternate Phone: - -         How did you hear about DAC? (Select) Word of Mouth Internet Search Engine Newspaper Other       What services would you like additional information on? In-Home Services Information and Referral Peer Counseling Computer Training Disability Rights Advocacy Other     How may we contact you?   Telephone   E-Mail   Postal Mail       Please share any additional comments you have:         You're now ready to submit the form. Thank you for your interest! We look forward to serving you!

OUR LOCATIONS   MOSCOW East 124 Third Street Moscow, Idaho 83843 208.883.0523 Voice / TTY 800.475.0070 Toll-Free Voice / TTY 208.883.0524 Facsimile E-Mail: moscow@dacnw.org Website: www.dacnw.org COEUR D'ALENE 1323 Sherman Avenue, Suite 7 Coeur d'Alene, Idaho 83814 208.664.9896 Voice / TTY 800.854.9500 Toll-Free Voice / TTY 208.666.1362 Facsimile E-Mail: cda@dacnw.org Website: www.dacnw.org LEWISTON 307 Nineteenth Street, Suite A-1 Lewiston, Idaho 83501 208.746.9033 Voice / TTY 208.746.1004 Facsimile E-Mail: lewiston@dacnw.org Website: www.dacnw.org

 

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