Danish Sisterhood of America Disaster Relief Request__________________

When disaster hits home it can be an emotionally and financially devastating event. In the spirit of why the Danish Sisterhood was started, we’re here to assist you as best we can.

Below are the criteria to be eligible for assistance.

• Fires, floods, hurricanes, tornadoes, earthquakes, wildfires and civil disturbances.

• Member of the Sisterhood 1-year or more, in good standing

• Must reside in the area affected (your home, not a rental)

• Displaced from home due to the disaster

• Assistance solely on need as determined by majority of the National Board

Member Name _______________________________________ Lodge # _________________

Member yrs Referred by_____________________________________________

Please explain member’s situation and need: _______________________________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

Would you be willing to let us print your story in the DSS Newsle6er? We would like to let our membership know where their dona;ons have gone and that we are working towards our relief goals. Y _____ N _____ (No $ amount will be noted for contributor or recipient)

Signature of Lodge President ____________________________________________ Date ______________ ________________________

To be completed by the Na1onal Board

Contributed Amount $______________ Match Amount $ _____________ Date Issued _________________