LAP-AID Network Member Application

LAP-AID Network Member Application

Thank you for your interest in becoming a Linn Area Partners Active in Disaster (LAP-AID) Network Member on behalf of your organization.
Please read the LAP-AID Network Member requirements below.

LAP-AID Network Membership

Network Members contribute knowledge and resources and remain connected during disaster response and recovery phases.

LAP-AID Network Members commit to the following:
- Staying connected through the LAP-AID email distribution list
- Voting on network-related matters
- Maintaining up-to-date contact information
- Attending meetings, trainings, and events when possible
- Collaborating with others during disaster response
- Serving disaster survivors with dignity
- Using approved procedures and forms for assistance
- Trusting and supporting the recommendations of fellow members
By completing this application, I understand that I will become a LAP-AID Network Member representing an organization and will assist in disaster preparedness, response, and recovery without making any formal or official commitment to organizational resources.
Name*
Job Title
Email*
example@example.com
Phone Number
Signature*

Clear
Date*

MonthDayYear
Date
ORGANIZATION INFORMATION
Name of Organization*
Type of Agency, Organization, or Program:
If other, please explain:
Please select which type of organization you represent:

BusinessChamberCivic ClubElected OfficialEmergency ManagementFaith CommunityFinancial InstitutionFoundationGovernmentHuman ServicesLegalMedicalMental/Emotional HealthSchoolYouth ProgrammingOther
If other, please explain:
Organization's Address
Organization's Email
example@example.com
Organization's Phone Number
Organization's Website URL
DISASTER CAPABILITIES CONTACT & ASSESSMENT
When a disaster strikes, and the Linn County Emergency Management Agency (EMA) activates the Emergency Operations Center (EOC), it is helpful for the EMA and the EOC to have access to designated 24/7 contact phone numbers for organizations that want to aid in the response and recovery efforts. The 24/7 phone number could only be called if the EOC is activated. If your organization has a number that can be called 24/7, please list that number below.
Phone Number
Please enter a valid phone number.
Please check the following roles that your organization can assist with before, during, and/or after a disaster:*

Animals/Pet Rescue & AssistanceCase Advocacy and Needs AssessmentChildcare and/or Children's ServicesClean-UpCommunicationsConstruction Coordination (ad hoc)CounselingData ManagementDonations ManagementElderly CareEmployment ProgramsFinancial AssistanceFood AssistanceFunctional Needs ResourcesHousing AssistanceInformation and ReferralLong-term Recovery (Rebuilding)Medical Assistance/ResponseMental Health ServicesPreparedness PlanningSpiritual CareTransportationProviding Volunteers and/or Volunteer CoordinationOther
If other, please explain:
Should be Empty:

LAP-AID Network Member Application

ORGANIZATION INFORMATION

DISASTER CAPABILITIES CONTACT & ASSESSMENT