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​Survey Form

Please take a moment to fill out the form.

How did you first learn about our organization? Required
If you have donated, what motivated you to donate to our organization? Required
Which of our programs do you find most beneficial? Required
May we add you to our monthly newsletters ?
Would you like to tour our facility

Thanks for submitting!

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The Conklin Davis Center for the Visually Impaired Logo

405 White Street

Daytona Beach, FL 32114

Copyright © 2023 by
Conklin Davis Center for the Visually Impaired
All Rights Reserved.
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