NYC Medics Japan Relief Resource Database
Please fill out this form if you are in Japan, Tokyo or north, and can provide assistance to a Medical team arriving from the US to assist in the relief effort. The type of assistance being requested is mostly with logistics and information. Our team(s) will be looking to find and then move quickly to underserved areas and will need to move quickly. A place to stay, help with transportation, and any information about local circumstances, is the type of assistance required. If you can help with any of these please fill out the form below. For up to date information on our work please visit http://nycmedics.org 
                                                                                                                                                         -Thank you for your help.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
email
Phone
Other method of contact?
Current Location
Please provide a description of the help you may be able to provide
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report