Request for Donations
Project C.U.R.E. is committed to helping those in need. Please request supplies only if there is an imminent shortage of supplies and/or equipment.
Facility Name *
Your answer
Facility Location *
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Type of facility *
Contact Name *
Your answer
Contact Phone Number (Primary) *
Your answer
Contact Phone Number (Secondary) *
Your answer
Contact Email *
Your answer
Which is your closest Project C.U.R.E. Distribution Center? *
Able to Pick-Up from the closet Project C.U.R.E. Distribution Center? *
Number of Providers? *
Your answer
Number of EMTs? *
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Number of First Responders? *
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How many days of supplies do you currently have? *
Your answer
Patients or Contacts / Day *
Your answer
Top Priorities (select 2) *
Required
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