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Survey Submission Form

If you are an organization that has received an update form, please fill in the information below. If you are part of an organization that would like to be considered for inclusion in the Almanac, please fill out the form and we will let you know if you have been accepted.

You can also email your information to CBannister@osv.com, or mail to Carrie Bannister, 200 Noll Plaza, Huntington, IN 46750.

Organization name:

What is the survey code at the bottom of your mailed form?

Survey Code
(from the bottom of your mailed form):

Please add the Mailing List ID found on the bottom of your form.

Mailing List ID
(from the bottom of your mailed form):

Who should be contact for more information?

Contact Name:

Title:

Address 1:

Address 2:

City:

State:

What is your ZIP code or your postal code?

ZIP or Postal Code:

Country:

Does your organization have a secondary address?

Second Address 1:

Second Address 2:

Telephone:

Extension:

Fax:

Web site address:

Email:

Other information:

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