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Sound the Alarm - NYC Appointment Request / Activa tu Alarma - NYC Solicitud de cita
Dear Resident, Please use this form to sign up for free Smoke Alarms installed by the Home Fire Campaign / American Red Cross in partnership with FDNY and FDNY Foundation.
(Please sign up only once)
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* Indicates required question
First Name / Nombre
*
Your answer
Last Name / Apellido
*
Your answer
Cell Phone Number / Teléfono Celular
*
Please enter only numbers e.g. 9291234567, no spaces, - , ( ) / Ingrese solo números, no espacios, - ,( )
Your answer
Email /Correo Electrónico
Your answer
Time of appointment
Please select one or more times you are available
Monday - Friday 10:00 AM - 4:00 PM
Weekends 10:00 AM - 4:00 PM
Street Address / Dirección
*
e.g. 520 West 49th Street NOTE: At this time, we
do not
serve residents in New York City Housing Authority (NYCHA) building.
Your answer
Apartment / Apartamento
e.g. 4, 4R, A
Your answer
Borough / City
*
Choose
Bronx
Brooklyn
Manhattan
Queens
Staten Island
Zip Code / Número Postal
*
Your answer
Note: Is this a NYCHA building? (At this time, we do not serve residents in New York City Housing Authority (NYCHA) building.)
Your answer
Where did you hear about this campaign? / ¿Dónde se enteró de esta campaña?
*
Tabling event / Mesa informativa
Referral from friend / family / Community group - Referral from friend / family / community group - Referido por Amigo / Familia / Grupo en la comunidad
Media announcement / Anuncio en medios de comunicación
Flyer or advertisement / Anuncio o publicidad
Door-to-door event / Evento puerta a puerta
Elected official / Oficiales Electos
Social Media (Facebook, Twitter, Instagram, etc) / Redes sociales
FDNY - FSE
FDNY -FSE/ Faith Based Organization
UJO-Chaveirim
Other:
Notes / Notas : i.e. Are you deaf or hard of hearing and need a Bedside Shaker or Strobe Alarm?/¿Necesita una alarma especial?"
Your answer
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