AED Recycle/Reuse Program 
AEDs have been donated to the Center for Resuscitation Medicine at the University of Minnesota from first responder agencies across the state.  These agencies have received new AEDs through a grant.  To further improve outcomes from sudden cardiac arrest; used AEDs are being updated and placed in communities with generous funding from the Lillehei Family Foundation and other private donors. 
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Email *
Applicant's name *
Applicant's email *
Applicant's phone number *
Location of where AED will be placed (name) *
Location of where AED will be placed (address) *
Why would an AED placed at this location be beneficial? *
What is the approximate population size of this location? *
Are there any existing AEDs in this location?
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Who will be responsible for the AED at this location? (name)
Email
Phone number
Do you agree to complete a transfer of responsibility and ownership? *
Are you interested in receiving CPR training?
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Would you prefer virtual or in person training?
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