Request For Southeast Louisiana Evacuation Guides & / Or

REQUEST FOR SOUTHEAST LOUISIANA EVACUATION GUIDES & / or AMERICAN RED CROSS PREPAREDNESS EDUCATION Please complete this form and email to [email protected] We would like ____ (number) copies of the Southeast Louisiana Citizen Awareness and Disaster Evacuation Guide. (Note: There are 250 guides in one box. A volunteer will call the contact indicated below to schedule a time that you may pick up your guides at our New Orleans office.)

Please come to our facility to provide an educational session to our employees or members about: ___ Emergency preparedness ___ Volunteer opportunities We are having an employee resource fair / community outreach event on (date) _________________________ We would like American Red Cross – Southeast Louisiana Chapter to participate by: ____ Providing a speaker on: ___ Emergency preparedness for individuals and families ___ Volunteer opportunities ____ Staffing a table with Red Cross information ____ Other (please specify): _____________________________________

Our company participates in employee volunteer programs ____ Yes ____ No If yes, please provide the name and contact information for the person who organizes employee volunteerism: Name: ______________________________________ Phone: ______________________________________ Email: _______________________________________ COMPANY/ORGANIZATION NAME: NUMBER OF EMPLOYEES: YOUR NAME: JOB TITLE: ADDRESS: CITY/STATE/ZIP: PHONE: EMAIL: