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Application
for Listing in Yellow Pages for Kids with Disabilities on Fetaweb.com
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If
you provide a service to parents and want to be listed on your state
Yellow Pages, please complete this form. The Yellow Pages are a free
service - there is no charge to be listed (privacy
policy).
*
Indicates required fields - These fields
must be filled in before the form can be processed.
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Provider
or Organization Name:
*
Required |
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Contact
Name:
*
Required |
In this
order: first name, middle initial, last name, suffix |
Address
line 1:
*Required
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| Address
line 2: |
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City:
*Required |
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State
or province:
*Required |
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| Country: |
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Zip
or postal code:
*Required
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Phone
number 1:
*Required
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| Phone
Number 2: |
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| Fax: |
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Email
Address:
*Required.
We will contact you when your info is added |
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Email
Address:
*Required.
Will appear in your listing. |
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| Website:
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| Description
of Services (optional) |
Choose
the service that best describes you:
*Required
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Description:
Describe your services (max. 35 words):
This field is optional |
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(NOTE:
We respect the
privacy of
our subscribers, contacts, those who respond to our surveys and questionnaires.)
If
you have a problems or need help, please send an
email
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