Request For Inclusion in the Senior Resource Connection Resource Guide

Welcome Service Provider

Please fill in all the information areas. You will notice that the e-mail and web site fields are not required, however, if you have a general company e-mail and web site and want them published, please do fill in these areas. The name given in the posting will not be published but will be considered the contact person for any follow-up that may be required.

Your information will be published free of charge. If you are interested in purchasing additional advertising in the Guide, please contact (937) 223-8246 ext 207. Thank you for your interest in the next edition of The Miami Valley Senior Resource Guide-information for older adults, caregivers and referring agencies.

Bold fields are required.
First Name*
Last Name*
Company Email
Company Website
Company*
Address*
City*
State* (eg. OH)
Zip* (eg. 45312)
Phone* (eg. 937-123-1234)
Category*
Description*  (maximum characters = 325)
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