Please provide your contact information in the fields indicated below. Your contact information will be used only for the purpose of seeking additional information about the personal protective equipment (“PPE”) you wish to donate to Team Kentucky.
First Name is required
Last Name is required
Phone Number is required
Phone Number is invalid
Example: 502-555-1234
Email Address is invalid
Number available is invalid
Please describe them.
Are you willing to transport your PPE donation to a collection facility? is required
signature is required