HOMELESS SERVICE PROVIDER
REGISTRATION FORM

The Kenny Nickelson Memorial Foundation For Homeless Veterans and Children, Inc.

To volunteer, please complete this form and click the "Submit Form" button to apply online, or print this page and complete the form by hand, then Fax the completed form to: (310) 939-7738

(* = required information) 
* KNMF Event:
* Event Date:
* Event Time:
* Organization:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Telephone:
Fax:
* Email:
Check if Applies: Legal Council/Advisors
To advise homeless veterans and formerly homeless veterans in transitional housing.
Legal Services Offered:
Name:
Email:
Telephone:
Names of Additional Participants:
Check if Applies: Medical/Dental/Eye Care Provider
Providers of medical, dental, and eye care services.
Health Care Services Offered:
Name:
Email:
Telephone:
Names of Additional Participants:
Check if Applies: Veteran Transitional Housing Provider
Will accept applications from qualified homeless veterans for placement in a continuum of care programs.
Housing Services Offered:
Name:
Email:
Telephone:
Names of Additional Participants:
 

Thank You!

For more information please contact:
Doris Nickelson
Phone: (310) 834-2507 - Fax: (310) 939-7738
KNMF
P.O. Box 3098
Manhattan Beach, CA 90266
Email for KNMF Info

 
 

With the generous support of donors, resources, and volunteers, KNMF has been able to help tens of thousands of needy individuals over the years by responding to their needs.

Personal identifiable information, including name, address, e-mail, and telephone/fax number provided by donors, volunteers, employers, colleges, trade schools, veteran service providers, or others is for the sole use of KNMF and will not be disclosed.  KNMF's policy on non-disclosure of personal identifiable information went into effect on December 14, 1991.

For more information, please contact Doris Nickelson: Telephone (310) 545-2937 FAX (310) 939-7738 or Email for KNMF Info