Organization Registration

Please fill out form with necessary information and click the submit button below.

Organization/Group Name	Friendly Village
Primary Phone	715-365-6857
Primary Email	cfisher@friendlyvillagerehab.com
Address	Friendly Village
Address Ln 2	900 Boyce Dr.
City	Rhinelander
State	Wi
Zip	54501

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

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