Red Cross Club Registration Survey

Please provide the following information to register your Red Cross club.

1. What is the name of the Red Cross unit that sponsors your club?

What is the name of the Red Cross unit that sponsors your club?

2. Please provide the following information for the Red Cross representative who serves as your club's primary contact.

Please provide the following information for the Red Cross representative who serves as your club's primary contact. Name of Primary Contact
Title
Telephone
Email

3. Name and Location of Club

Name and Location of Club Name of Club
City
State
Zip Code

4. Contact Information for Club President

Contact Information for Club President Club President Name
Email
Telephone
Anticipated Year of Graduation

*

5. Is this club sponsored by a school?

Is this club sponsored by a school? Yes

No