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Contact Information
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Phone Number
*
Email
*
Verify Email
*
Your Region
*
select one
Central Gulf Coast
Northeast
Midwest
Pacific Northwest
Pacific Southwest
Rocky Mountain
Southeast
How to Determine Your Region
Central Gulf Coast (CGC):
New Mexico, Texas, Oklahoma, Arkansas & Louisiana
Northeast (NER):
Maine, New Hampshire, Vermont, New York, Pennsylvania, Massachusetts, Rhode Island, Connecticut, New Jersey, Delaware, Maryland, Virginia, West Virginia
Canada Provinces:
Quebec, New Brunswick, Nova Scotia, PEI, Newfoundland & Labrador
Midwest (MWR):
Minnesota, Wisconsin, Michigan, Iowa, Illinois, Indiana, Ohio & Missouri
Canada Province:
Ontario
Pacific Northwest (PNW):
Washington, Oregon, Idaho & Alaska
Canada Provinces:
British Columbia, Alberta, & Yukon
Pacific Southwest (PSW):
California, Nevada, Arizona & Hawaii
Rocky Mountain (RMR):
Montana, North Dakota, Wyoming, South Dakota, Nebraska, Utah, Colorado & Kansas
Canada Provinces:
Saskatchewan, Manitoba, Northwest Territory & Nunavet
Southeast (SER):
Kentucky, Tennessee, North Carolina, Mississippi, Alabama, Georgia, South Carolina & Florida
How to Determine Your Region Copy
Central Gulf Coast (CGC):
New Mexico, Texas, Oklahoma, Arkansas & Louisiana
Northeast (NER):
Maine, New Hampshire, Vermont, New York, Pennsylvania, Massachusetts, Rhode Island, Connecticut, New Jersey, Delaware, Maryland, Virginia, West Virginia
Canada Provinces:
Quebec, New Brunswick, Nova Scotia, PEI, Newfoundland & Labrador
Midwest (MWR):
Minnesota, Wisconsin, Michigan, Iowa, Illinois, Indiana, Ohio & Missouri
Canada Province:
Ontario
Pacific Northwest (PNW):
Washington, Oregon, Idaho & Alaska
Canada Provinces:
British Columbia, Alberta, & Yukon
Pacific Southwest (PSW):
California, Nevada, Arizona & Hawaii
Rocky Mountain (RMR):
Montana, North Dakota, Wyoming, South Dakota, Nebraska, Utah, Colorado & Kansas
Canada Provinces:
Saskatchewan, Manitoba, Northwest Territory & Nunavet
Southeast (SER):
Kentucky, Tennessee, North Carolina, Mississippi, Alabama, Georgia, South Carolina & Florida
Type of Membership
*
select one
Handler
Team Leader
Associate
Membership Types
Handler
: Volunteer with their canines to deploy to crises and disasters.
Team
Leader
: Supervise and support canine/handler teams during crisis and disaster deployments.
Associate
: Volunteer unique skills and talents to support the work of HOPE AACR, without deploying to crises or disasters.
Why are you interested in Animal-Assisted Crisis Response?
*
Canine's Name (please use your last name)
*
First Name
Last Name
Canine's Breed
*
Canine's Date of Birth
*
(mm/dd/yyyy)
Is your canine spayed or neutered?
*
select one
Yes
No
Current AAT Team?: *required for membership
*
select one
Yes
No
AAT Organization: *required for membership
*
Examples include but are not limited to: Alliance of Therapy Dogs, Bright & Beautiful Therapy Dogs, Love on a Leash, or Pet Partners.
AAT Badge/Registration Letter
Click here to upload a photo of your AAT badge or AAT membership acceptance letter. PDFs are also accepted.
How long (in years) in AAT with the canine listed on this application?:
*
Tell us more about your canine:
*
Tell us more about your skills and interest:
*
How did you hear about HOPE AACR?
select one
Search Engine (Google, etc)
Social Media
News Media
Peer Referral
Other
If Other, please describe:
*
