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.
Type of Organization
Event Coordinator Name
If Referred by a Red Cross representative, list name here.
What role does the referral have at Red Cross?
Health & Safety Representative
Blood Services Representative
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
Veteran/Active Military Fair
Disaster Preparedness Fair
Is the Red Cross hosting a blood drive at your event?
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
Youth Under 18
Will you provide any of the following equipment items?
Are there any registration or parking fees associated with this event? (Red Cross is unable to participate in events unless the fees are waived)
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?
Is your event open to the general public?
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