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): Click to use same name and contact information as 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 SpotmeĀ® 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 *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 **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 Please email Program & Administrative Manager, Kim Schechter, at kschechter@womensderm.org if you would like to request the WDS registered logo for use, or have any other special requests. 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. Continue