Greater Pennsylvania - Preparedness Request

Virtual Presentation Request Form for Pennsylvania
To request a Red Cross presentation for your group, please fill out the form below. We apologize that we may be unable to fulfill requests for events that are submitted less than 3 weeks in advance. PLEASE NOTE: THIS REQUEST FORM IS FOR GROUPS IN PENNSYLVANIA.

* indicates required field

Please note: This form does NOT support the Philadelphia area. If you are in the Philadelphia area and would like to talk to us about Preparedness, please click here.
Type of Audience:
Presentation:
Name of Group Requesting Presentation:
Name of Contact:

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Event Date and Time of Presentation:
Is the Date / Time Flexible? (Flexibility of scheduling results in a greater likelihood that we can match a volunteer ambassador to your request.)
Address of Organization Requesting Virtual Event (must be in Pennsylvania):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County Organization Resides In:
Estimated Number of Attendees:
How did you hear about our programs?
Additional Details or Comments:
Should be Empty:

Virtual Presentation Request Form for Pennsylvania