Community Education Materials Request Form for Hospitals and Transplant Centers

Carolina Donor Services partners with hospitals across our service area to raise community awareness of the importance of donation. We are happy to provide materials about donation to your hospital free of charge. Please complete the below form and let us know how we can help. Available materials are pictured and described here. Please submit requests at least two weeks prior to when the materials/speaker will be needed. 
 

   * Required Fields

Name: *
Hospital Name:*
Hospital Address:		City:		State:		Zip Code:
County:				Email : *
Phone Number:*				Fax Number:

We would like the following materials:

Donation Materials:
	Quantity		Quantity
		General Information Rack Cards -English (pkg. of 50)		Carolina Donor Services Friends For Life Volunteer Brochure (pkg. of 50)
		General Information Rack Cards -Spanish (pkg. of 50)		Donate Life Flag
		Table Top Rack Card Holder		Carolina Donor Services Partner’s for Life Hospital Newsletter
		Say, “Yes.” Educational DVD (17 minutes)
		Donate Life North Carolina Paper Enrollment Forms (pad of 100)

Donation/Transplantation Articles:
If you check any of the boxes in this section, CDS' Marketing and Events Coordinator will be in touch with you regarding your specialized needs.
			Donation/transplantation related articles to print in employee newsletter
			Donation/transplantation related articles to print in community-focused newsletter
			Donation/transplantation related articles and links to post on hospital website
			Donation/transplantation related posts for your organization’s Facebook page
Request for Speaker:
		We would like a speaker for a hospital event.

		Event Date:		Event Time:
		Event Name:		Event Location:
		Audience Size:		Topic of interest
		Additional Information:
Special Requests or Questions?