2. Offer to Help During Emergency
   For offers of help during a declared state of emergency please fill out this form and introduce yourself, your skills and how you would like to help.
3. 
5. First Name*
6. Last Name*
7. Middle Initial
9. Address
   The address below must be your resident physical address. If you have a PO Box please enter it as well in case we send out mailers.
11. Street Name*
12. City*
14. Ashfield POBox/Address
15. State*
16. Zip*
18. Phone Number*
19. Email Address*
23. Skills*

    Select all skills that apply. Please add details or specifics in the comment section below. For example if you enter "Medical" then enter what type like Nurse or EMT.

    1. Medical
    2. Clerical
    3. Other (describe in the comments section below)

    1. Rescue
    2. Firefighting

    1. Animal rescue
    2. Transportation

    1. Heavy equipment
    2. Chainsaw
25. Comments
29. Shelter Volunteer

    I would be interested in becoming an emergency shelter volunteer. Please note that all shelter volunteers will be background checked (CORI).

    1. No
    2. Yes
33. Are You in BlackBoard Connect System?

    Are you in the Town's phone broadcast system? If you would like to add your name or make changes in it add/Select the type of Reverse 911 action you are requesting from the following options:

    1. Add to the list

    1. Change information

    1. Remove from the list
Leave This Blank:


39. Submit

* indicates a required field