Championing Early Defibrillation in Your Community DVD

To place an order for additional copies of the DVD (a $20 value), please complete the form below or contact us at 1-888-201-0229.

The list price is $20/per DVD. Normal discounts will apply.

* Indicates required field.

PERSONAL INFORMATION
First Name
Last Name
Position/Title
Company/Institution
Department
Address
Address 2
City
State
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Country
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QUESTIONS

1. Please check the box if you would like to receive information about new products or specials by e-mail.
Yes

2. What has heightened your interest in community early defibrillation
Media Coverage
Advertisement
Newspaper/Journal Article
Web
Personal Connection
Other

3. Are you aware of existing AED programs (or AED use) in your community?
Businesses
Municipal Offices/Buildings
Healthcare Facilities
Other

4. Is your community considering an early defibrillation program? If so, please note the timeframe:
Urgent
0 to 6 months
6 to 12 months
12+ months
12+ months
Unsure

5. What form of follow-up would you like
Literature and video only
Follow up call after receipt of video
Price quote to incorporate a Public Access Program

6. Is your implementation project funded
Yes
No

7. Please note the number of DVDs you would like to order. (The list price is $20/per DVD. Normal discounts will apply.)

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