Minnesota Horse Council Disaster Response Team Application Name: ______________________________________ Address: ___________________________________ City: ________________________ State: ____ Zip: _________ Phone: ___________ Alt Phone: ___________ Fax: ____________ Email: ____________________________________________ Website URL: ___________________________________________ Brief description regarding your involvement with horses: _______________________________________________________________________ _______________________________________________________________________ What organizations do you belong to? __________________________________ Please check the follow services you are able to provide: County Area Coordinator* _____ Truck/trailer ____ Vet ____ Communications ____ Feed Donations ____ Hay transport ____ Loan of Corral Panels ____ Horse Holding areas ____ Air support/rescue ____ Other**: ____________________________________________________ *The County Coordinator is responsible for organizing people in the county and maintaining up-to-date phone numbers, etc. **Other: Please explain on the back of this sheet. Complete this sheet and return to the Minnesota Horse Council. To contact the committee directly: Minnesota Horse Council Disaster Response Team Marian Robinson, Chairperson 4630 Golden Valley Road Golden Valley, MN 55422. Phone: 763-588-0297 evenings and weekends e-mail: mariana_1820@yahoo.com