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Through Organ & Tissue Donation

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Join Team Philadelphia:

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Register to be a part of Team Philadelphia as we compete for the gold!

 

Volunteer Feedback Form

Thank you for taking the time to submit your volunteer activity information. Please enter your information and click the "Submit Feedback" button. Please note that the asterisks (*) indicate required fields. Your information cannot be accepted without all required fields.


* Required Fields
Sponsoring Organization*
Volunteer First Name*
Volunteer Last Name*
Coalition*
BerksCape Atlantic
CapitalCentral PA
Central Susq. ValleyDelaware - North or South
Donors Are HeroesHearts of Gold
Liaisons for LifeLehigh Valley
Multicultural AffairsNortheast PA
South CentralSouthern NJ
Not Affiliated
Event Type*
Community ProgramSchool Program
Hospital ProgramFaith-Based Program
Other
Event Date*
Start Time-End Time*
Number of Hours Worked*
Street Address*
City*
State*
Zip Code*
County*
Contact Name*
Contact Email Address
Contact Phone Number
Number of Attendees*
Number of Meaningful Conversations - If at a larger event, how many one-on-one conversations did you have addressing further questions about organ and tissue donation?
Did you have the capability to register audience members as organ and tissue donors?*
YesNo
If yes, what format did you use to register audience members?
Online registration via a laptop or IpadPaper forms
How many people were you able to register as donors?
Comments
Type of Event*
Speaking EngagementTabling Event
Other

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Register for the 2015 Dash

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The 20th Annual Donor Dash is designed to help promote organ and tissue donation and highlight the success of transplantation.

April 19, 2015.

Learn more about the event and register today!

 
 
 
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