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Donation Form

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Please correct the field(s) marked in red below:

Please enter details about the items you want to donate below.

Currently we only accept the following items:

  • CPAP Machine
  • Face Shields
  • Hand Sanitizer
  • N95 Masks
  • Surgical Gloves
  • Surgical Gowns
  • Ventilators
1
Item(s)
 *
2
Quantity
3
Condition
4
Date Available
5
Your Name
6
Contact (phone and/or email)
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