First Responder/Health Care Masks

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"lets be a part of the solution to the shortage"

Email *

THANK YOU FOR YOUR SERVICE!!!

If you are trying to receive a mask for yourself or your agency, please fill out this form. Unfortunately due to the high demand and limited resource's, filling out this form does not guarantee that we will be able to provide masks to everyone. We are working as fast as we can to provide our local Heroes with these masks. First Responders and Health Care workers local to the Northern Kentucky area will take priority first. We hope that we can get masks in the hands of all those requesting one.

Name (First and Last) *

Phone Number: *

Shipping Address: (Street, city, state, zip) *

Agency/Healthcare provider you work for? *

How many masks do you need? (If its more than (1) please explain below who the other masks are for i.e. they're for an agency) *

If you selected more than 1 mask, please provide an explanation as to why you need multiple masks and who they will be given to:

Thank you for reaching out to us. Again, we will try to get as many masks out to our local first responders and health care professionals as we can. We will reach out to you via email if/when we are able to provide you with your selected request.

A copy of your responses will be emailed to the address you provided.

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