Volunteer Connection
IS: Measles and Rubella Presentation Request Form
To effectively staff events and support American Red Cross preparedness and outreach efforts,
requests received with less than 30 days’ notice cannot be honored unless otherwise stated.
Every day, measles takes the lives of hundreds of children around the world. Even if a child survives, measles can cause permanent disabilities, such as blindness or brain damage. But there is hope. This presentation discusses the role of the American Red Cross and our global partners in the Measles and Rubella Initiative, including what your community can do to reach our goal of total eradication of the diseases by the year 2020.
Request Form
Organization Name
Type of Organization
Event Coordinator Name
Phone Number
Email
If Referred by a Red Cross representative, list name here.
What role does the referral have at Red Cross?
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Community Ambassador
Health & Safety Representative
Blood Services Representative
Executive Director
Volunteer
Fundraising
Government Relations
Not Applicable
Other
For the safety of our Red Cross volunteers, info booths must be in secure public venues and may not be on sidewalks, in restaurants, in front of private property, and/or parking lots.
Type of Event
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Health Fair
Community/Neighborhood Fair
Conferences/Expos
International/Independence Fair
Veteran/Active Military Fair
Disaster Preparedness Fair
Other
Event Description
Is the Red Cross hosting a blood drive at your event?
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Yes
No
Event Name
Event Date (Events received with less than 30 days’ notice cannot be honored,unless otherwise stated.)
Event Street Address
Event City (Must be in Los Angeles County)
Event Zip Code
Red Cross Arrival/Setup Time
Event Start Time
Event End Time
Why would you like an M&RI presentation at your event?
Approximate # of Event Attendees
Main Event Demographics
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Youth Under 18
General (Individuals/Communities)
Seniors
Business
Faith Based
Military/Veteran
Immigrant/Refugee
Families
Will you provide any of the following equipment items?
Computer/Laptop
Projector
Screen/Blank Wall
Speakers
Not Applicable
Are there any registration or parking fees associated with this event? (Red Cross is unable to participate in events unless the fees are waived)
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Yes
No
Parking (Please provide instructions below)
Point of Contact for Day of Event
Point of Contact Name
Point of Contact Cell Phone
Has ARC previously participated at this event?
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Yes
No
Is your event open to the general public?
Select ...
Yes
No
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