Community Outreach Form
What is the best number to reach you? (Please use format xxx-xxx-xxxx)
Please provide an email address so we can get in touch.
Please enter your street address here, be sure to include any apartment numbers.
Please enter your mailing address CITY here
Please enter your mailing address STATE here
Please enter your mailing address ZIP CODE here
Please select from below the statement that describes you the best.
I, or someone I know, is a searching patient
I want to help raise awareness of a searching patient I heard of
I, or someone I know, donated
I want to help raise awareness about being a donor
I want to raise awareness of Be The Match at my college
I want to raise awareness of Be The Match at my work
Please tell us more if you selected Other in the previous field
Please tell us what organization or school you are with. If your inquiry is related to a patient, please enter the patient name here.
How did you hear about us?
Please tell us how you heard about Be The Match?
I know a searching patient
I know someone who donated
I was at an event
I heard about you through my school
Please tell us more if you selected Other in the previous field.
How can we work together?
Please select the option that best describes your interest in working with Be The Match. You can also use the Additional Information section at the end of the form to help describe your specific interest.
Share a story (communication assistance)
Host digital event on social media
Host community event
Individual volunteer opportunities
Group volunteer opportunities
Fundraising for Be The Match
Fundraising for searching patient
Please indicate here if you have a date in mind for your desired activity.
Is there anything else it would help us to know? NOTE: Patients and donors are most likely to be matched to one another based on their ethnic background. So, if your efforts are in honor of a specific patient or donor, please indicate his/her ethnic background here.
Helpful links -Facebook pages, company websites...
please paste any helpful links here such as an event link, news article, facebook page, corporation site etc. Also, please enter any social media handles you want to share with us.
Current Be The Match Contacts
Please enter the names of anyone you're already in contact with at Be The Match
Please verify your email address
Send me a copy of my responses
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