HDSA Event Kit

Please allow 2 Weeks shipping time. Orders will only be shipped using a ground service. Please plan accordingly.

Tell us who you are and where are we shipping to...

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Event information

Event Name *

Type of Event *

Event Date * +

What state is this event happening in *

Expected attendance *

Please select the region your event is in *

Materials Requested

Select All that Apply (items while supplies last) *

Do you have any questions or special requests?

Submitted by:

Name: *

E-mail address *