Become a Member Member Intake Form Name of Organization: * First Name Last Name Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Phone: Country (###) ### #### Website: http:// Name of Authorized Member Organizational Representative: Primary Contact First Name Last Name Phone: Country (###) ### #### Email: * Languages: Name of Alternate Member Organizational Representative Secondary Contact First Name Last Name Phone: Country (###) ### #### Email: Languages: Organization Information: What resources can your organization provide to the VOAD in times of emergencies/disasters? (Mark all that apply) Donation/Volunteer Coordination Outreach/ Information Disaster Case Mgmt./Recovery Preparedness/ Mitigation Mass Care/Sheltering Food Assistance Recovery Housing Assistance Animal Welfare Health Services Elderly/Child Care Transportation Communications Counseling Emotional/Spiritual Care Other (Identify Below) Thank you!
