Dialogue Store Application Form
Dialogue is an online network for survivors, researchers and support providers of servicewomen and families affected by military moral injury. This form represents an application for a store account in the Dialogue Social Network, a product of the Moral Injury Support Network for Servicewomen, Inc. The purpose of this form is to gather the information needed to determine if the applying organization is a good fit for the purposes and audience of Dialogue.

Exclusivity is one of the most important benefits Dialogue provides. Those organizations that are accepted get guaranteed exclusivity for their products or location. In other words, part of what providers are buying is direct access to customers with no competition from other organizations that provide the same goods and services or work in the same region. The information requested here will help the committee determine if the applying organization is offering a product or service not already represented in the network or if it is serving a unique area. Moral Injury Support Network for Servicewomen, Inc. reserves the right to disapprove any application based on non-exclusivity or incomplete information.

For questions or concerns, contact:
Dr. Daniel L. Roberts
President and CEO
Moral Injury Support Network for Servicewomen, Inc.
droberts@chaplainconsultants.com
910-690-5964
Email address *
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