Community Information Survey

We’re working to gather information to help our Local Fire Department as well as find out those who might have resources or skills and would be willing to help in an emergency event

Contact us at:

info@preparealbion.com

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Name *

First

Last

Phone Number (Optional)

Physical Address *

This information will be used to assist the Fire Department in emergency situations.

City *AlbionAlbionDecloElbaAlmoMalta

Number in Household *112345678910

Do You Have Anyone Who Requires Assistance to Leave the Home? *

• Yes
• No

Is There Anyone in the Home That Requires Oxygen or Electric Dependent Medical Devices? *

• Yes
• No

Special Skills & Resources (Check all that apply)

• Medical Training
• Heavy Equipment Owner/Operator
• Food Preservation/Canning
• Communications
• Other (please note in comments)

any Address the

Please note any applicable resources or skills that you may have.

Would you like further contact?

• Yes
• No

Submit