Donation form

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Donation form

This form will allow Story County Emergency Management to compile a list of items to be donated. Once the response is received, it will allow for proper collection and distribution with our local partners in need for protective personal equipment (PPE).

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* Indicates required question

First and last name. *

Your answer

Phone Number *

Your answer

Email Address *

Your answer

Items and Quantity to be donated *

Your answer

Fair Market Value of items.

Your answer

Submit

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