Apply for Member & Family Advisory Council Join the MFAC Name(Required) First Last Phone(Required)Email(Required) Preferred Contact Method (choose one)(Required)PhoneEmailAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Are you an ACANYMember/Self-advocateFamily MemberRepresentative/AdvocateEthnicity(Required) Black or African American Asian Native Hawaiian or Other Pacific Islander White Other Choose One(Required) Hispanic or Latino Not Hispanic or Latino Preferred Language(Required)How long have you been involved in services for yourself/your loved one?(Required)0-55-1010-1520+ yearsWhy do you want to join the MFAC?(Required)What special interests, skills or experience can you offer to the MFAC?(Required)Are you affiliated with any other groups or organizations that could be helpful to the council?(Required)What areas do you have the most experience with?(Required) Self Direction Certified Residential Setting (IRAs) Community Habilitation Day Habilitation Housing Employment Respite Family Support Services Environmental Modifications Adaptive Technology Behavioral Health Care/Mental Health Services Complex Medical Conditions Other If other, please explain.(Required)CAPTCHA