Materials Request Form
Event Name
Event Date
Your Name
Your Email
Are you:
Staff
Volunteer
Your role:
CDL
DPC
Other
Region
Please select...
East Bay
Fresno
Nevada
NoMo
South Bay
West Bay
DSA
Event Type
Please select...
Tabling
Hospital Presentation
School Presentation
DMV Presentation
Faith Based
Symposium/Forum
Conference
Pink Dot/Red Heart Club
Restock (not attached to an event)
Other
Restock requests that need shipped will only be sent FedEx Ground
Estimated Attendance
Estimated Students
Number of Class Periods
Please select...
1
2
3
4
5
6
7
8
9
Service
Service Requested
Please select...
Materials will be picked up at a Regional Office
Materials need to be shipped directly to Volunteer or Event Location
Pick up at Regional Office
Please select...
Fresno
Redding
Reno
San Jose
San Ramon
Stockton
Date materials will be picked up
Date shipment needs to arrive at destination
If materials are being shipped to a Volunteer or an Event location,
please put the address and phone number here.
Additional Instructions
Please give full address and phone if materials are to be shipped
Hospital Services
Pens
Black ink, referral #
Clinical Cue Cards
Badge Pulls
Clinical Cue Cards - Badges
Cardiac Death Referral Guide
Transitional Language Card
FPA Escalation Flow Chart
FPA Leave Behind
Donate Life Flag - English - Large
Done Vida Flag - Spanish - Large
Donate Life Flag - English - Small
Phone Stickers
Mouse Pads
Brochures
English
Spanish
African American
Filipino
Punjabi
Tissue
Volunteer
Posters - 11x17
Organ Posters
Tissue Posters
Spanish Posters
Vietnamese Posters
Do you need any Faith-based materials?
Yes
No
Faith-based materials
English
Pope Francis Prayer Cards
Guadalupe Prayer Cards
Guadalupe Posters
Caucasian Faith Hope Life Posters
Caucasian Faith Hope Life Bulletins
African American Faith Hope Life Posters
African American Faith Hope Life Bulletins
Spanish
Pope Francis Prayer Cards
Guadalupe Prayer Cards
Guadalupe Posters
Hispanic Faith Hope Life Posters
Hispanic Faith Hope Life Bulletins
Filipino
Filipino Faith Hope Life Posters
Filipino Faith Hope Life Bulletins
Punjabi
Punjabi Faith Hope Life Posters
Punjabi Faith Hope Life Bulletins
Registration Forms
English
Spanish
Chinese
Giveaways
Green Bracelets
English Pens
Spanish Pens
DL Window Clings
Hand Sanitizers
Donate Life Balloons
Educator Resource Guides (for teachers)
#DONATELIFE stickers (blue)
#DONATELIFE stickers (multi)
#ORGANDONOR stickers (blue)
#ORGANDONOR stickers (multi)
Pink Donor Dot stickers
Red Donor Heart stickers
Other
Please indicate any special off list items here on separate lines and we will let you know if they are available.
Please be sure to include any appreciation gift(s) you may want for your primary contact into the quantity you request for that item.
Premium Giveaways - limited quantities - only for registrations/call to action/appreciation gift
Grocery Totes
Carabiners
Stress Balls
DL Car Magnets
English Water Tumblers
Spanish Water Tumblers
DL Ball Caps
DNW Lanyards
ITEMS BELOW MUST BE RETURNED AFTER EVENT
Please note: we will try to accommodate your banner preferences but may need to substitute due to availability.
Is your event indoors or outside?
Please select...
Inside
Outside
English Tablecloths
Spanish Tablecloths
Clip Boards
English Vertical Banners
Please select...
Caucasian
Hispanic
African American
Filipino
Mixed Race
Spanish Vertical Banners
Please select...
Hispanic
Brochure Holders
English Tabletop Banners
Please select...
Caucasian
Hispanic
African American
Filipino
Mixed Race
Spanish Tabletop Banners
Please select...
Hispanic
Baskets
Other
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Contact Information