Membership Interest Form EmailThis field is for validation purposes and should be left unchanged.After reviewing the membership criteria, do you meet all the requirements for membership?(Required) Yes No Full Name(Required)Organization(Required)E-mail(Required)Desired Membership Level (Please Reference Membership Criteria for Details)(Required) National Member Associate Member Has Your Organization held an IRS tax-exempt status for at least two years?(Required) Yes No Does your organization have national capacity? (In order to qualify for membership, organizations must have national capacity)(Required) Yes No Please detail your national capacity & activity in Presidentially Declared Disasters in the past three years:(Required)Total Number of Volunteers (Engaged in the past year):(Required)Please indicate which State/Territory VOAD your organization currently holds active membership with: (To qualify for the NATIONAL membership category, organizations must be a current and active member of at least five State/Territory VOADs)(Required) Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Please Select a Minimum of 5Please indicate which State/Territory VOAD your organization currently holds active membership with: (To qualify for the ASSOCIATE membership category, organizations must be a current and active member of at least one State/Territory VOAD for a minimum of one year)(Required) Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Select a Minimum of OneDomestic Disaster Budget:(Required)Organizational Budget(Required)Total Number of Staff and Volunteers(Required)Organizational Capabilities(Required) Bulk Distribution Case Management Childcare Debris Removal/ Gutting/Chainsaw Dental Care Disaster Casework/ Disaster Emotional/ Spiritual Care Donations Management Emergency Communications Family Reunification Feeding Financial Assistance Laundry Units Legal Support Logistics Long-Term Recovery Group Support Medical Care Medication Replacement/Durable Medical Equipment Mold Remediation and Sanitizing Pet Care/Sheltering Public Health Rebuild/Repair Refugee Resettlement Relocation Services Sheltering Shower Units Technology Support Unaffiliated Volunteer Management Volunteer Housing Volunteer Reception Center Select All That ApplyOther Capabilities
