LA5 Face Shield Request Form
In response to the COVID-19 health crisis, the Rotary Club of Los Angeles Foundation will donate face shields that will be assembled by LA5 Rotary Club members for use by frontline healthcare and safety workers.

We know the demand and need for this type of equipment is high and supplies are limited.

Upon completion of this form, your request will be expeditiously reviewed and based upon the information you provide our organization will be in touch to confirm number of shields and delivery dates based on supply and need.

Please answer the following questions to submit your request.
Email address *
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