Resilience Alliance Partner Registration
Organization Name
*
Organization Type
*
Please Select
Business
Non-Profit
Faith Organization/Religious
School
Philanthropic
Political/Governmental
Number of Members/Employees
*
Local groups your organization works most closely with:
Does your organization have the following?
Preparedness Plan
Response Plan
Recovery Plan
Evacuation Plan
Continuity of Operations Plan
Does your organization have an emergency PREPAREDNESS plan?
*
Yes
No
Does your organization have an emergency RESPONSE plan?
*
Yes
No
Does your organization have an emergency RECOVERY plan?
*
Yes
No
Does your organization have an emergency EVACUATION plan?
*
Yes
No
Does your organization have an emergency CONTINUITY OF OPERATIONS plan?
*
Yes
No
Does your organization have formal or informal agreements in place with other community resources for times of emergency?
*
Yes
No
If YES, please describe
Considering the organization's resources and equipment, what might you be able to offer to support the broader community's preparedness, response, and recovery efforts in the table below:
Building space: shelter, storage, etc.
Meeting space
Goods/essential supplies
Services
Vehicles
Heavy equipment
Grants to support community projects
Other
Organization Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Website
Facebook Handle
(www.facebook.com/________)
Instagram Handle
(www.instagram.com/________)
Primary Contact Name
*
First Name
Last Name
Primary Contact Title
*
Primary Contact Phone Number
*
Please enter a valid phone number.
Primary Contact Email
*
example@example.com
Secondary Contact Name
First Name
Last Name
Secondary Contact Title
Secondary Contact Phone Number
Please enter a valid phone number.
Secondary Contact Email
example@example.com
Additional Members
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
What other opportunities are you interested in?
Networking with other Resilience Alliance partners
Hosting a networking event
Participating in Vibrant Hawaiʻi community events
Volunteer opportunities
Other
Would you be interested in scheduling a free First Aid/CPR certification workshop or Hands Only CPR Training for your employees?
Yes
No
Would you like to learn more about our work based learning program, ʻIliahikū?
Yes
No
Are you interested in volunteering for our Kaukau 4 Keiki program in the Summer?
Yes
No
Attestation
I have the authority to enter into this agreement on behalf of the organization listed above
I agree to receive electronic news (opportunities for training and announcements) from Vibrant Hawaiʻi about the Resilience Alliance
I agree to allow Vibrant Hawaiʻi to utilize our company logo for Resilience Alliance promotional purposes (Vibrant Hawaiʻi website, newsletter, and social media)
Please upload a high resolution logo file for promotional purposes
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