1. Community Event Request

Thank you for your interest in the American Red Cross. Please fill out this brief survey with as much detail as possible so that we may fully understand your request.

We regret that we will not be able to honor any requests submitted prior to 60 days or with less than fifteen (15) business days notice.

* 1. Event Name

* 2. Please select the choice that most closely describes what type of event this is.

* 3. Date and time of the event

Start Date
End Date
Start Time
End Time

* 4. If your event has multiple dates and times, please use this field to provide that additional information.

* 5. Event location

* 6. Event details

* 7. Please describe how you would like the Red Cross to be involved at your event

* 8. Please describe the target audience for this event

* 9. How many people are expected to attend

* 10. Is there a registration fee

* 11. Would we be able to:

  Yes No
Collect donations
Distribute informational materials
Sell products

* 12. Other comments

* 13. Please provide the website for your company or organization and/or the website for the event, if applicable

* 14. Contact information