Disaster Relief Fund Application for Assistance
For Dental Technicians and Dental Laboratory Owners Affected by Natural Disasters
Whether it's a hurricane, dangerous wildfires or flooding caused by overflowing rivers, the National Association of Dental Laboratories (NADL) is here to offer a helping hand.
In 2005 NADL created the NADL Disaster Relief Fund in order to provide monetary assistance to individuals in the dental laboratory profession who have been affected by a natural disaster.
State / Province / Region
Postal / Zip Code
Describe the nature of what natural disaster impacted you and how, from a personal and business perspective.
Describe how you plan to use emergency funds.
Describe how you have been able to receive assistance from local, state and federal disaster programs since the disaster impacted your area:
Can you accept U.S. Mail, UPS and/or Fed Ex deliveries at your temporary location?
If not, do you have a bank institution where you can accept a wire transfer?
Bank Contact Person, if available (Name and Phone Number)
Name on Account
How should payments of assistance be made payable? (In a business name or you personally). Please provide this in writing.
For shipping purposes, is your temporary location a business or residence?
Grants provided by NADL Disaster Relief Fund will depend upon funds available and be at the discretion of the board of directors. Grants are awarded on a firstcome first serve basis and eligibility is limited to individuals or businesses, located in those areas designated under the Presidential disaster order.
I certify that I have suffered a disaster to my dental laboratory and/or residence as stated in this application.
I certify that the information contained in this application is true and complete. I understand that a fraudulent representation or omission of any information provided is grounds for immediate refusal to grant assistance under this program.
I understand that the granting of such assistance is neither a right nor entitlement and that the NADL shall have sole discretion in determining whether I qualify for assistance.
Signature and Date
National Association of Dental Laboratories 325 John Knox Road, Ste L103 Tallahassee, FL 32303
800-950-1150 (Phone) 850-222-0053 (Fax) www.nadl.org