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Primary Contact

Name*

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Title

Email*

Phone

Best Contact Method

Organization Name*

Organization type*

Organization's Street Address

Organization's ZIP Code

Organization's Website URL*

Florida Area*

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County*

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Organization's Zip Code

If different than above, please designate a preferred contact person for Florida Leaders in Lifesaving

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Title

Alternative Email

Phone

Do you report to Shelter Animals Count, Shelter Pet Data Alliance, or both?*

Shelter Animals Count

Shelter Pet Data Alliance

Both

Neither, but I would like to learn more

Aspect of animal welfare you are most passionate about:

Aspect of animal welfare you find most frustrating:

Number one opportunity to increase lifesaving in your community:

Number one barrier to increase in lifesaving in your community:

Top area of expertise you and/or your team possess that can help others:

Top area that you and/or your team would welcome assistance from other members:

Upload your organization's logo (vertically aligned preferred)*

Accepted file types: jpg, gif, png, Max. file size: 5 MB.

Your logo will be displayed on the Current Members page and link to your organization's page on the site. Maximum logo file size is 100kb.

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