Membership Application
Organization Name *
Your answer
Street Address (include city, state & zip) *
Your answer
Mailing Address (if different than above - include city, state & zip) *
Your answer
Office Phone *
Your answer
Fax Number
Your answer
Website *
Your answer
Contact Information
State the name and contact information for the main and secondary contacts for SLO VOAD. These persons must provide complete information for each category and be willing to be reached at any time in case of emergency.
Primary Contact Name *
Your answer
Email *
Your answer
Mobile/24-hour Emergency Phone *
Your answer
Home Phone *
Your answer
Secondary Contact Name
Your answer
Email
Your answer
Mobile/24-hour emergency
Your answer
Tertiary Contact Name
Your answer
Email *
Your answer
Mobile/24-hour emergency
Your answer
Requested membership category *
Mission Statement
Please provide the organization’s mission statement. Include information on its disaster program if applicable. (A separate document with the mission statement may be emailed.)
Mission Statement
Your answer
Available Resources Offered by Agency
You may consider the following services when providing the following information:
Preparedness/Mitigation
Response/Relief
Recovery
Material Resources and Services
List the material resources and services that your organization intends to offer during or after a disaster.

Examples:
Material Resources: 5 horse trailers that hold 2 horses each, facility that could serve as a collection site for clothing, disaster preparedness literature.

Material Resources
Your answer
Human Services
Please list the number of staff/volunteers your organization would have available to help in times of disaster and their special skills or training:

Examples:
5 caseworkers, 4 truck drivers, 6 childcare workers, 3 animal shelter workers.

Staff/Volunteers
Your answer
Shelter and Disaster Plans
Shelter and Disaster Plans
Yes
No
Could your facility be used as a shelter?
Does your organization have a written Emergency Action Plan (to protect life and property)?
Does your organization have a written Disaster Response Plan (to respond to the community's needs)?
If no, would you be interested in assistance towards developing one?
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