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Lockport Shield Assistance

2. If you are in need of assistance due to the Coronavirus (COVID-19) outbreak, please let us know. We have a team of volunteers that are ready to deploy to help come along side you during this time. All we ask is that you provide a few pieces of key information so that we can best serve you.

   If you are in need of assistance due to the Coronavirus (COVID-19) outbreak, please let us know. We have a team of volunteers that are ready to deploy to help come along side you during this time. All we ask is that you provide a few pieces of key information so that we can best serve you.

4. First Name*

5. Last Name*

7. Phone*

8. Email

10. Address1*

12. Address2

14. City

15. State

16. Zip

18. Seeking*

    Please provide a brief description of what type of assistance you are looking for.

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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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