Sign Up for Chattanooga DSA COVID Mutual Aid
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What's your name? *
Where are you located? (Neighborhood or city) *
Phone number *
Email address (put any letter or number if none) *
Are you, or is anyone in your household, currently displaying coronavirus symptoms? (We will help you regardless, we just want to be sure to protect our own members who are vulnerable!) *
How can we assist you?  (In all cases we will either provide assistance ourself or do our best to connect you with the appropriate resources) *
Required
Any extra information about your request?
Please enter a deadline date if this is time-sensitive - we will do our best to accommodate
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Please enter a preferred time if this needs to be done by or during a certain time of the day
Time
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Do you want to be added to Chattanooga DSA's email notification list? (for updates on programs, events, etc.) *
DSA members will be as kind and respectful as possible to me, and I agree to do the same *
Required
DSA agrees to help to whatever extent we deem possible and triage requests based on urgency to the best of our ability, and I agree to be respectful of DSA volunteers' time and resource limitations, and I acknowledge DSA might not be able to help me *
Required
I agree to contact the DSA Harassment and Grievance officer with any concerns about members' conduct, by emailing ChattDSAHGO@gmail.com or calling/texting 423-226-1787 *
Required
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