Black & Pink Food Distribution: Sign Up!

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Black & Pink National is excited to partner with Whispering Roots to distribute food in Omaha to our local members and their families throughout April!

Please fill out this form to be considered for USDA Food Boxes in Omaha with our partners at Whispering Roots. This form must be submitted by Wednesday at 12p CT every week; you will hear from our Wellness Coordinator (Brooke) who will provide additional information for picking up your food boxes on Fridays between 3:30-4:30p CT.

This support is intended for LGBTQIA2S+ people & people living with HIV/AIDS who are affected by the criminal punishment system & their families. Food boxes include produce, meat, and dairy, and are intended to support families of 4 for 2-3 days.

Email *

Full Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Are you able to pickup boxes on Wednesday between 10-11am? *

Yes

Someone Besides Me Will Be Picking Up For Family

Do you have access to a vehicle? (Recommended) *

Yes

Other:

Provide Name of Person Picking Up Boxes *

Number of Adults in Home *

Number of Children in Home *

Number of Seniors in Home *

Preferred Contact *

Phone

Required

A copy of your responses will be emailed to the address you provided.

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