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Mobility Aid Need Form
While we cannot guarantee that MALL can fill your need immediately, knowing that you have this need will help us match you with the appropriate item when we receive it.

If you have a donation, please fill out the form here:

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Email *
I need... *
Anything you would care to tell us about your need?
First Name: *
Last Name: *
E-mail Address: *
Phone: *
Can you pick up this item?
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A copy of your responses will be emailed to the address you provided.
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