Emergency Requests


By submitting this form,

  1. I confirm that the information I have provided here is complete and accurate to the best of my knowledge.

  2. I confirm that I wish to share the information provided here with Rise Against COVID-19 for the exclusive purpose(s) of searching for emergency resources. 

  3. I agree to hold harmless Rise Against COVID-19 for its use of the information for the exclusive purpose(s) set out above.

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