Service Request Form
Please provide information on the services you need to help us streamline our work.

RMCER - Regina Muslim Community Emergency Response is a group of volunteers who are dedicating their time to support this initiative. Please note that filling of this form does not guarantee provision of services; RMCER's services will be delivered on a best-effort basis.
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First Name *
Last Name *
Which language do you prefer? *
Phone Number *
Email Address
Address *
Age Group *
What kind of support do you need? *
Emergency Contact
International Students - we are offering free grocery shopping and delivery to international students. Are you an international student? *
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