Let’s raise together Name * First Name Last Name Email * Phone (###) ### #### Do you represent an EMS or Fire Department/Organization? * Yes No Is your organization a registered 501c(3) or (4)? * Please note, we only accept applications from registered non-profit organizations who can supply documentation of active registration. Yes No Where is your organization located/registered? * Additional Comments Thank you for reaching out. We will contact you in one business day.
