To Register Your Disaster Interfaith
Please complete the membership application form to join NDIN.
A. Organization
Organization:
Type:
Program Focus:
 
B. Contact Information
Title:  
First Name: Last Name:
Position Title:
   
Phone 1: Ex:123.123.2345 Phone 2:
Cell Phone: Fax:
Email:
Web:
   
C. Location
Office Address: floor/office:
City:
State: Zip code:
 
Mailing Address: floor/office:
City:
State: Zip code:
 
D. Services/programs your organization provides:
 
Advocacy
Case Management
Chaplaincy/Spiritual Care
Child/youth Services
Disaster Relief
Donations Management
Emergency Servives
General Social Services
Health Services
Mental Health Services
Preparedness
Recovery Coordination
Training/Certifications
Volunteer Management
Work Camps
Others: