Initial Contact Form

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Initial Member contact form

In order for us to better aid you in this time of need please complete this form.

Please complete the form below, all information will be kept in strict confidence.

 If you prefer, you may simply call 1-603-672-9185 ext 2 to provide the information.

Current Information

   

    Full name: 

    Street: Apt/Suite:

    City: State: Zip:

    Tel: FAX: Cell:

    E-Mail:     Is this Temporary? Yes or No

    PMI Chapter: PMI Member #:

    How have you been affected?

   

    What are your needs?

   

    Additional information:

   

    If the address above is temporary please give permanent address.

    Street: Apt/Suite:

    City: State: Zip:

    Tel: FAX: Cell:

    E-Mail:     Will you stay or Relocate

               

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NOTE: MDRI is a 501(c)(3) charitable organization (tax id 3122).
Donations are tax-deductible to the fullest extent of US law.

MDRI is not formally related to the Project Management Institute (PMI) or its Educational Foundation.
 "PMI" is a registered trademark of the Project Management Institute, Inc.
For more information on the PMI, visit www.pmi.org 

Copyright (c) 2005-7 Members Disaster Relief Inc. All rights reserved.
For problems or questions regarding this Web site contact President@membersdisasterrelief.org.
Last updated: 01/01/08.