Use the following form to help conduct your public education programs and request supplies to support your efforts. 

    Your Information *

  • What is your affiliation with Gift of Hope? *

    Program Information

  • Program Date & Time

  • Program Address *


  • Program Contact

  • Program Details

    Type of Program (select all that apply) *

    Health FairOutreach ProgramDonation Education TableFamily EventSpecial Event (please specify)



    Number of Attendees *

  • Do you Need Support Materials?

    Type of Speaker (Select all that apply)

    Gift of Hope Staff (clinical, marketing)Tissue RecipientOrgan RecipientDonor FamilyWaitlist Candidate

    Location



    Describe Audience *


    Materials

    Quantities will determined by Gift of Hope Public Relations Department based on expected attendees

    Standard Brochures

    General EnglishGeneral African-AmericanGeneral SpanishInterfaith Brochure
    If you chose Interfaith Brochure – Specify Faith in the box below
  • Standard Giveaways

    Gift of Hope Pens (Community)TableclothsWristbandsGOH Pins

    Method of Delivery

    Picking Up Materials? Pick up Date:
  • Location of Pick-Up
  • Want the Materials Mailed?


Gift of Hope has teamed up with LifeGoesOn.com to make it easy to become an organ and tissue donor. Visit www.lifegoeson.com to join the registry today.

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