Name of Group Representative (ex. John Adams):
Position/Role in Organization or Group (ex. Volunteer Coordinator):
Email (ex. email@example.com):
Phone Number (ex. 310-455-9900):
Street Address of Organization (ex. 1345 Main Street):
City (ex. Los Angeles):
Zip Code (ex. 90025):
Group Size (ex. 15):
1st Desired Date for GVO for Build-A-Kit (Enter specific date):
Desired Time for GVO (Enter specific time range):
Have you or your group participated in a GVO in the past? If Yes, please specify date and opportunity name.
What lead you to choose Red Cross for your group service? If referred by a Red Cross representative, list name below.
Are you and/or any of your group participants under the age of 18?