Parents Against Tip-overs Sign Up

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First Name

Last Name

Address

Phone Number

Email Address

Organization Name (if applicable)

Website (if applicable)

What brings you to be interested in PAT?

I am a parent of a child who passed away in a tip-over.

I am a family member or family friend of a child who passed away in a tip-over.

I am a parent of a child injured in a tip-over.

I am a parent of a child involved with a near miss tip-over.

I am a concerned consumer.

Other:

Clear selection

How active would you like to be in PAT? Check all that apply.

I am willing to travel

Letter writing to advocate

Presenting/Speaking

I will sign/share petitions

I can help recruit members

I can educate families in my area

Keep me informed, not sure if I can do more

Other:

Please share your story with us. This will give us important information on the scope of the problem of tip-overs as well as allow us all to know each other better. (Please limit response to 500 words or less, but be sure to include as many details as possible – child age, location of dresser, type of dresser, brand, model, number of drawers, impact on your family, etc.)

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