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This information will only be used for mailing list information (email address) and in the case of dire emergency. It will be held confidential by the Administrators of the Harbor. A head count is needed for the application of grants. UNDER NO CIRCUMSTANCE WILL THIS INFORMATION BE SHARED WITH ANYONE!! {PLEASE HELP US GET OUR GRANTS TO KEEP YOUR HARBOR RUNNING. We would like to keep you posted on upcoming events, and send out a newsletter. There is no intention of asking anyone for  money, other than by contributions that anyone would like to freely give. This is not why this form is here!   Thank you!

You only need to fill this form out once! ;-)

Please provide the following contact information:

Nickname is the name you are planning on using in our discussion forum. Please fill it in and when you enter the chat you can put it in instead of guest. This will be the name that everyone on the chat will know you as.

 

First Name
Last Name
Street Address
Address (cont.)
City
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Zip/Postal Code
Country
E-mail
URL

Please identify and describe yourself:

 

Nickname:
Date of Birth
Sex Male Female

 

BEFORE ENTERING THE CHATROOMS PLEASE READ THE DISCUSSION GUIDELINES THAT CAN BE FOUND AT: https://harbor-of-refuge.org/harborchat.html after you have done so....

Please feel free to Enter our Discussion but until you are interviewed by one of our "ops" you must stay in the room #harbor-of-refuge...Thanks!

WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE THAT DOESN'T WANT TO ABIDE BY OUR GUIDELINES

 
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Copyright � 1999  All rights reserved.
Revised: July 16, 2001