Survey - Help the American Lung Association Distribute Masks

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Help the American Lung Association Distribute Masks

As part of our COVID19 Initiative, the American Lung Association is happy to provide free face masks to help reduce the spread of disease until we are all breathing easier. Made in the US, it is 100% soft, breathable 2-ply cotton, reusable and washable.

*1.

Question - Required - Are you interested in receiving CDC masks from the American Lung Association?

Yes, my organization would like to request a donation of American Lung Association face masks. Please give us the name and shipping address to where the masks are going.

Name:

First Required	Last Required

Email: Required

Address Line 1: Required

Address Line 2 (Optional): Required

City/State/ZIP:

City Required	State Required	ZIP Required

Yes, I would like to receive e-mail from the American Lung Association

Yes, I would like to receive postal mail from American Lung Association

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*3.

Question - Required - Where will these masks be distributed?

(Maximum response 255 chars, approx. 5 rows of text)

*4.

Question - Required - Please indicate the quantity of masks needed, with a maximum of 500 masks.