Individual Membership Application

* = Required field

Last Name
First Name		Middle Initial
Nick Name
Address Line 1
Address Line 2
City		State / Province
Postal Code		Country
Home phone
Work phone
Mobile phone
Fax
Email Address - Primary
Email Address - Other
The Foundation is looking for highly motivated, caring individuals who are interested in joining a unique team and making a difference in the lives of those who must face disaster. If you are a mental health professional, former airline family assistance team member or a caring individual with relevant experience then we would like to consider you for our Foundation Care Team. If you wish to apply to the Foundation's Care Team, and to be trained in Human Services Response™ in order to be called upon to respond during a crisis, please select NEXT If you are joining the Family Assistance Foundation as an individual member, but do not wish to volunteer as a responder at this time, please select SUBMIT

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