Coast-2-Coast Toolkit Request Form

Your Information

* Name:

Institution:

Address 1:

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

Event Information

* Outreach Activity Planned (please describe):

* Location of Event:

* Date of Event:

* Time of Event:

* Expected Number of Participants:

* Age Range of Participants:

Material Request

Address for shipping (if different from above):

Shipping Address 1:

Shipping Address 2:

* Shipping City:

* Shipping State/Province:

* Shipping ZIP/Postal Code:

* Shipping Country:

* 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:

2 Small Collapsible Baskets
1 Medium Collapsible Baskets
1 Large Collapsible Baskets
2 Long Clip Boards
2 Short Clip Boards
Hand Held Mirrors
1 Boxes of Latex Free Gloves
1 Large bag of Alcohol wipes
1 Navy Table Cloth

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 - English
WDS Play Safe in the Sun Card - Spanish
TOPS Tips for Kids Card
WDS Free Skin Cancer Screening sign

*Note that these items are an additional cost to the WDS, please submit your request based on your expected event attendance

WDS Materials
Please indicate quantity for each.

Membership Applications
Membership Brochures
Awards Brochures
WDS Registered Logo for usage

**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

Thank you for hosting a Coast-2-Coast event! We want to showcase your volunteerism on our website and in our newsletter. Please send recaps and any photos to wds@womensderm.org.