Request for ARC Genesee-Lapeer Chapter Participation

Please provide the following information:

Name
Title
Organization
Work Phone
E-mail

When will the event take place?

-- mm/dd/yy

--time of event

Location of event:

Red Cross Facility
Your Facility
Other Facility

If you checked a Your Facility or Other Facility, please enter the address:

What is the size of the expected audience?

Under 10
10 - 20
21 - 50
51 - 100
Over 100

What age group is the expected audience?

Families
Children
Teens
College-age
Adults
Seniors

In which of the following topics are you interested? Check ALL that apply.

General overview of the Red Cross
Fundraising Opportunities
Blood Services
Disaster Services
Service to Military Families and Veterans
Health & Safety - First Aid
Health & Safety - CPR
Health & Safety - Water Safety
Health & Safety - Youth Programs
Emergency Preparedness
Volunteer Opportunities

Is there any other information you wish to share?