Virginia Beach Mayor's Committee for Persons with Disabilities Online Application

Type of Membership

Individual (Disabled)

Individual (family member of a Disabled Individual)

Service Provider

Organization

Ex-officio

Organization Information

Ex-offcio

Name

Phone Number

Educational Background

Occupation/Employer

Civic/Volunteer Activities

Additional Background Information

Describe your involvement/interests with Persons/issues for Persons with Disabilities.

Why are you interested in serving on this Committee?