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SOUTHERN NEVADA CENTER
FOR INDEPENDENT LIVING
ONLINE DIRECTORY
 

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Request for Future Edition


Please add our business/organization to the next edition of the Disability Pocket Guide.

We would like to be included in the next edition. Please send a questionnaire form for our FREE listing to:

Name ______________________________________________________

Title ______________________________________________________

Business/Organization ________________________________________

Address ___________________________________________________

Suite _________________  P. O. Box ____________________________

City___________________________ State__________ Zip___________

phone (________) _______________  fax (________) _______________

Please indicate the category in which you would like to be listed, and/or your main products or services:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

_____________________________________________________

Please print out and mail this form to SNCIL, 6039 Eldora, Suite H-8, Las Vegas NV 89146

or fax back to (702) 889-4574.

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