Emergency Contact Form — Stella Maris Property Owners' Association

Emergency Contact & Preferred Contact Form

The contents of this form are for the express use of the Stella Maris Property Owners' Association (SMPOA) Board of Directors and for the purpose of emergency contact only unless expressly stated. No information will be distributed to any other party. While every effort will be attempted to use this form to contact Members in the event of an emergency to give a status update as soon as possible, please remember that weather and road conditions may prevent access for a number of days.

Primary Contact Name *

Primary Contact Name

First Name

Last Name

Primary Contact Email Address *

Please enter the email you would like to receive communications from us.

Primary Contact Phone Number On Island *

Please enter either your landline or cell number. If you have both, please enter both.

Primary Contact Phone Number Off Island *

Please enter your overseas BEST telephone number

Off Island Primary Address

Optional Physical Address off Island

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary Contact Name

First Name

Last Name

Secondary Contact Email Address

Secondary Contact Phone Number Off Island

Please enter the best phone number to reach you with area code.

Additional Contact Name 1

First Name

Last Name

Additional Contact Email Address

Emergency Off Island Contact Name *

Emergency Off Island Contact Name

In the event of an emergency who should we reach out to?

First Name

Last Name

Emergency Off Island Contact Relationship

Please list your relationship: i.e., Son/Friend/Cousin

Emergency Off Island Best Contact *

Email? Phone? Please enter!

ON ISLAND Emergency Contact Name

Do you have someone on island that you would like us to contact? Caretaker/Friend/Trade?

First Name

Last Name

ON ISLAND Emergency Best Contact

What is the best method to reach your on island contact (note communications may be down for a number of days)

HOUSE LOCATION & DESCRIPTION *

Please describe where your house is by Master Map Number (see attached), Name (i.e. "The White House") and also color/style

Additional Instructions/Comments

Is there anything else you would like us to know or to contact?