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Business Name:(Please add your organization/agency name here.)
Business Title:(Please add your title here (Director, Assistant, RN, ect.).)
Business Type:(Please choose your business type:)
Services & Products:(Please describe any services and products that your organization/agency offers here.)
Twitter Username:(An example username would be "dhnohio" if the client's Twitter page was http://twitter.com/dhnohio)
Facebook Profile ID:(An example profile ID would be "Disability-Housing-Network/124487767672621" if the client's Facebook page was http://www.facebook.com/pages/Disability-Housing-Network/124487767672621)
LinkedIn Username:(An example username would be "dhn" if the client's LinkedIn page was http://www.linkedin.com/pub/dhn)
Board Role:((For DHN Board Members only))
Counties Served:(Please list all of the counties that you provide services for in this area.)
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