Cares Form | Team W.H.I.P.

top of page

Home
W.H.I.P.
Outreach
- Services
- Caregivers
Events
DONATE
Resources
- Health Care
- Mental Care
Contact
Media
Shop

Let Us Help

WHIP Cares for YOU

Allow Team WHIP to be a resource.

Simply complete and submit the form below and our Cares Coordinator will be in contact. If you do not have an email address or need assistance with completing the form, please call 334-333-9405.

First Name

Phone

Last Name

Email

Choose a service

Street Address

City

Postal / Zip code

Bldg, Apt, Unit #

State

Country

Gender at Birth *

Female

Male

Ethnicity *

Black/African

White/Caucasian

Hispanic/Latino

Asian

Other

Age at the time of diagnosis *

Ages 18 - 25

Ages 26 - 39

Age 40 - 55

Ages 56 - 69

Age 70+

Thanks for submitting!

Team W.H.I.P.

Team WHIP is a registered non-profit public 501(c)3 tax exempt organization serving the Chambers & Lee Counties in Alabama, and West Point of Troup and Harris Counties of Georgia

Stay Connected to WHIP

Email: info@teamwhip2015.com

Phone: 334.333.9405

Registered Public Charity: Team WHIP

EIN. 47-5501256

Subscribe to WHIP

Thanks for submitting!

Team WHIP embrace and encourage our differences in age, color, ethnicity, gender identity, physical and mental ability, race, religion, socioeconomic status. We are committed to cultivating and preserving a culture of diversity, equity, and inclusion.

bottom of page