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Connected Community
Connected community card
Are you or someone you know in need of resources? If so, please consider filling out the Connected Community Card below and someone from our Team will get back to you shortly!
First Name
Last Name
Email
Phone
Address 1
Address 2
Country
City
State
Zip/Postal Code
Is this card for you or someone else?
This card is for me (Please fill in your name if it is for you).
This card is for someone else.
I would like to learn more about (check all that apply):
Food
Housing
Clothing
Donations
Medical Help
Social Services
Treatment/Recovery
How did you hear about us?
Anything else you'd like to share?
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