CONTACT INFORMATION
Please check the corresponding boxes below for the information you would like to receive from AIM for the Handicapped, Inc.:

I would like to know more about:

AIM workshops

AIM in my classroom

AIM in nursing homes

AIM Memberships

Special Events

Other: ________________________________________________________________________

Please tell us about yourself:
I am a:
Parent Administrator
Teacher Activity Director
Other (Please Describe) __________________________________________________________

Contact Information:

Name:__________________________________________________________________________

Email Address:___________________________________________________________________

School / Other Business: ____________________________________________________________

Street Address: __________________________________________________________________

City: ______________________________ ST: _____________ Zip Code: ____________________

Phone: ________________________________ Fax: _____________________________________

Please mail the completed form to:

AIM for the Handicapped, Inc.
945 Danbury Rd
Dayton, OH 45420

Or fax it to:

(937) 294-3783