Salvation Army Team Emergency Radio Network

Health and Welfare Information Request Form

Please use this form to submit your inquiry. Your inquiry will be sent to the disaster area, where SATERN personell will attempt to locate the person or persons about whom you are inquiring. Please supply as much information as possible. Thank you. Please enter your personal information so we can deliver any replies to your inquiry. First Name: Last Name: Address: City: State/Province: Zip/Postal code: Country: Phone Number: E-mail Address:

Please enter the following information about the person about whom you are inquiring: First Name: Last Name: Address: City: State/Province: Zip/Postal code: Country: Phone Number:

Please enter anything else to aid in locating the person about whom you are inquiring. Thank you to for the use of their service.

Privacy Statement The information submitted here will be used only for the purpose of locating and determining the health and welfare of the person or persons about whom you are inquiring and for replying to your request. We will not use this information for any other purpose.

© 1998 Paul Graham - K9ERG

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