DACCS Membership Application

Name of Individual
or Organization:_______________________________________________________________________

Address:_____________________________________________________________________________

_____________________________________________________________________________________

Daytime Telephone:_________________________________

Current Date:______________________________________

Please make checks payable to DACCS.
Mail to: P. O. Box 1235, Danville, Virginia 24543-1235

Monthly meetings (except December) at Ryan's Every 4th Friday at noon.
November meetings are the 3rd Friday due to the Thanksgiving Holidays.

Please list three (3) organizational representatives if this is an organization or agency membership.

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Welcome to DACCS