Coast-2-Coast Toolkit Request Form

Your Information *Name:
Institution:
*Address:
Address 2:
*City:
State/Province:
ZIP/Postal Code:
*Country:
*Phone:
*Email:
*Are you a WDS Member?
Note: Coast-to-Coast Toolkits are available to WDS Members only.
Yes, I am a WDS Member or my WDS Membership is pending

*Outreach Activity Planned (please describe):

*Location of Event:
*Date of Event:
*Time of Event:
*Expected Number of Participants:
*Age Range of Participants:
Address for shipping (if different from above):

*Date you would like items to arrive:
Additional comments:

Please check all items you would like shipped to you.

Play Safe in the Sun Supply Crate
Check box to select. Crate Includes:

3 Small Collapsible Baskets
2 Medium Collapsible Baskets
3 Large Collapsible Baskets
8 Long Clip Boards
3 Short Clip Boards
2 Hand Held Mirrors
3 Boxes of Latex Free Gloves
1 Large bag of Alcohol wipes
2 Table Cloths
1 School Supply Bag

Additional Materials
Please indicate quantity for each.
AAD Spotme® Skin Screening Registration and Report Forms
La Roche-Posay Sunscreen Samples
WDS UV Detecting Bracelets*
WDS Play Safe in the Sun Card
TOPS Tips for Kids Card

WDS Materials
Please indicate quantity for each.
Membership Applications
Membership Brochures
Awards Brochures
IJWD Journal Info Cards

*Note that these items are an additional cost to the WDS, please submit your request based on your expected event attendance
**All items unused after your event should be shipped back to the WDS National Office, shipping labels will be pre-paid and included for your convenience
***WDS strives to meet each member's toolkit request and requirements. However, toolkit materials are dependent upon inventory and distributed on a first come, first served basis