Program Type
Coat & Shoe Program
Shoe Program
Coat Program
First Name
Last Name
Email
Organization Name
Which best describes your organization?
Firefighters
Rotary
Faith Based
Service Club
Other
IAFF Local Number
Rotary District Number
If applicable - Tax ID Number (EIN)
Job Title
Phone
State/Province
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Country
USA
Canada
Zip
How many children under 3rd grade do you expect to give shoes to?
36-99
100-249
250-499
500+
How many children under 6th grade do you expect to give coats to?
36-149
150-299
300-499
500-999
1000-2499
2500-4999
5000-9999
Online Fundraising Options
I do not have a fundraising page, please create one
I do not need an online fundraising page
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