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Yantic River Flooding - Emergency Contact Form

  1. Logo

    EM Small LOGO

  2. Yantic River Flooding Emergency Contact Form

  3. Property Type*

    Type of Building

  4. Contact Type*

  5. Name of Individual Business/Complex

  6. Primary Contact Information

    First Person Contacted in the event of Flooding or impact.

  7. Text Capable?*

  8. Secondary Contact

    Secondary Contact in the event of flooding

  9. Text Capable

  10. Leave This Blank:

  11. This field is not part of the form submission.