The MMIHS.ORG family is working on creating a map to depict the general locations of MMIHS families and help people connect. If you choose to submit your location a "pin" will simply be placed on the map where you live. No names or contact information will be shared on the website.

However, at the bottom of the page there will be a link where a viewer could request contact with a given "pin"/ location. If you would like me to forward that request to you, you can indicate that below. If you choose to keep all of your information confidential you may indicate that as well.

If you have any questions before completing the survey please contact us at admin@mmihs.org.

Thank you!

Question Title

* 1. Type your name below.
Please note: this is only for record keeping purposes. Your name will never be shared without your consent.

Question Title

* 2. In which city, state and/or country do you currently reside? Please only provide as much information you are comfortable sharing and remember, no names or contact information will be shared directly on the website.

Question Title

* 3. If you would like to be notified if a viewer would like to contact you please provide your e-mail address below.

Question Title

* 4. Do you know anyone else who should receive this survey that we have not contacted? If so please forward them the link or list their name and contact information so we can! If not, thank you for completing the survey and we look forward to placing your pin!

T