International Y2K Cooperation Center

Country Request Form

(To be completed by Y2K National Coordinators and their Sector Leaders only)
For additional information, please contact YES HELP via:

Contact Information
Name: Languages Spoken:
Office: Title:
Work Address: Additional Address:
City: State/
City:  State/
Country: Postal Code: Country: Postal Code:
Phone: Fax: Phone: Fax:

Request Information

I am requesting assistance in the following areas (please check all that apply):
Also, identify one as your priority need
Technical Sector-Specific Management
Y2K project planning Power Overall project coordination
Y2K testing Nuclear power
Y2K assessment Water & sewer Project Management (PM)
Y2K IV&V Telecommunications PM - enterprise level
Y2K embedded systems Airports PM - community level
Y2K file conversion Air transportation PM - national level
Y2K bridges/data screens/etc. Energy
Y2K remediation options Banking & financial Contingency Planning (CP)
PCs/microcomputers Food CP - IT technical
Repeatable processes Ground transportation CP - enterprise continuity
Networks, LANs, WANs Chemical manufacturing CP - government operations
Computing hardware Shipping & ports
Communications equipment Health care Emergency management
Other:  Agriculture Risk assessment/management
Military Triage/criticality assessment
Other:  Y2K legal/legislative
Out/insource management
Human resource issues

Assistance Information

I would appreciate assistance in the following manner (please check all that apply):
In-person Email Tele/videoconference  Videotaped session
Other Resources/materials (please describe items to be donated, e.g. videos, papers, templates, toolkits) 


Indemnity Agreement

I, as the Y2K National Coordinator for , have requested to participate in and receive assistance from the YES Corps and its volunteers to provide technical expertise and support, in-person or via email, for conferences and/or programs identified by myself.  I understand that the YES Volunteers are donating their time, skills and expertise without compensation.  Furthermore, by submitting this form, I am affirming that I indemnify and hold harmless YES Volunteers, the YES Corps, the International Y2K Cooperation Center, and the officers, directors, employees, affiliates, sponsors, successors and assigns from, but not limited to any and all claims, losses, damages, expenses (including legal fees), suits, demands, or liens that arise out of or result from any acts or omissions of YES Volunteers, including the introduction or recommendation of YES Volunteers to the National Coordinator by the International Y2K Cooperation Center or YES Corps.