Gift of Hope provides donor registration drives, education programs and
speakers at no charge. 

Please note we can provide programs only for groups or
audiences of 100 people or more.

To help us best meet your needs, please provide three options for
dates and times for your registration drive, program or speaker.

Your Information
   
Your First Name
Your Last Name
City
County
Phone
Best time to call
E-mail
Where the program will be held
 
Name of company/organization
Contact Name
Phone
Address

Location of program (Suite #, cafeteria, etc.) 
City
State
Zip
Program Information
 
Requested dates and times
First choice of date: 
 Time(s):
Second choice of date: 
 Time(s):
Third choice of date: 
 Time(s):
   
Type of Program
Health Fair/donor
registration table
Speaker
Other
Audience (community, church congregation, nurses):
 
# of attendees expected:
Program topic/focus
(donor registry, general donation info, referral process, etc.):
 
Speaker requested Yes No
If yes, length of presentation:
 
Speaker experience preferred
(donation professional, donor family, heart recipient, etc.):
 
   
Additional questions or information for us