Safe Room Project Application For the Private
Saferoom
You must fill out this application
fully or it will be returned to you. You must supply the founders with
a "real" e-mail address. A real one means no yahoo, hotmail or any other
free one like that. In the rare case that someone does not have a real
one please e-mail the founders and we can see if there is anything else
you can substitute for the e-mail address. The founders will NOT share
the info requested here with anyone nor will we be using it for anything
other then Saferoom business. If you wish for the invite and any other
mail to be delivered to a different e-mail address then supplied for in
the e-mail field please note it in the comment field.
What is your real first name?
What is your last name?(optional)
What is your Saferoom name? *************Must have registered this
already
What is your "REAL" E-mail address? By real we mean not a free one
or a web based one?
What is your gender?
What is your age?
Were you abused?
If you answered yes to being abused please take a moment to answer these
Were you abused as a child?
Were you abused by someone you knew?
Thanks so much for taking the time to answer these questions. We will
be sending the invites to The SafeRoom
Project to the e-mail address you gave us just now. Should you want
the invite to go someplace else please fill in
below. Also if there are any comments you would like a founder to know
please use the space we have provided or
e-mail us at saferoomproject@yahoo.com.
All graphics belong to the founders of Saferoom. Please do not remove
the graphics without consent of the founders.
last updated Last updated 12/24/99 by Mrs88888
