Personal Protection Equipment Survey
RequiredRequired Question(s)
The Nonprofit Chamber has received a donation for Personal Protection Equipment (PPE) to share with our member organizations. We will email distribution details to people the week of July 20th. Non-Members can fill out this form and we will let you know if we have left-over PPE.
 
1.
Are you a Member Organizaiton of the Nonprofit Chamber of Service?
Yes
No
We would like to join!
  • Comment:

  • 500 characters left.
2.
How many REUSABLE masks could your organization use for employees and/or clients (max 100, multiples of 5)?
5
100
Other  
  • Comment:

  • 500 characters left.
Required 3.
Please enter the information indicated below. 

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code: