Help Haiti
Page One
The CARICOM Secretariat wishes to thank the Caribbean People for their overwhelming expressions of support and solidarity with the People of our sister CARICOM Member State of Haiti in this time of tragedy and crisis.
Nationals of the Caribbean Community including French, French Creole Patois speakers, who are willing to make available their expertise and services to the Community’s response to this tragedy, are invited to provide contact details and other information by using this short questionnaire.
Contact Details:
Email:
helphaiti@caricom.org
Tel: 592-222-0011 to 15 ext 2740 or 2763
Note
: If you are unable to complete this quesionnaire for any reason please send the answers to the questions below to helphaiti@caricom.org
1.
Please specify your contact category
Business
Civilian
NGO
2.
Please specify your contact details.
Note
: Your
Name
,
Street Address
and
Country of Residence
are required. All other fields are optional, however, you should also specify a way for us to contact you (either your Email Address, Phone Number or Mobile Phone).
First Name
Last Name
Designation
Organisation
Street Address
Apt/Suite/Office
City
State
Postal Code
Country of Residence
Email Address
Phone Number
Fax Number
Mobile Phone
3.
Please specify your Offer of Assistance and/or Area of Expertise
4.
Remarks
Online Surveys
powered by SurveyGizmo
