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Ant Directory Questionnaire, and then fill out the form below, and review the terms and conditions. Note that you will appear in the directory for 90 days. After 90 days, your profile will be deleted, but you can resubmit this form at that time in order to stay in the directory. Sign and mail back both sheets to Concepts of Independence at 120 Wall Street, 9th Floor, New York, NY 10005, Attn: Meghan Taylor, or fax to 888-557-5439or email mtaylor coiny.org. Note: In order to be listed in the dire.

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