LifeShare Registry

WORKPLACE PARTNERS

Education and awareness are the keys to saving lives. Please join the LifeShare Workplace Partnership. We would be thrilled to have you as a partner! Say Yes, Oklahoma!

Please complete all of the fields below.

* Company/Organization:

* CEO/Executive Director:

* Mailing Address

* City

* State

* Zip

Physical Address

City

State

Zip

Web site

http://

* Name and Title of Key Contact Person

* Phone

Fax

* Number of employees in your company/organization in Oklahoma

* Number of employees in your company/organization in the U.S.

* Email

To help LifeShare serve you better, please complete the following:

We will commit to (number) activities per

Month

Quarter

Year

We have chosen to reach every employee with the Donate Life Oklahoma message by (see Action Ideas sheet for further explanation), select as many as appropriate:

Electronic Sharing

Paper Distribution

On-site donor awareness program

In-house donor registration drive

Undecided

Other

We will also share the Donate Life Oklahoma message with our clients and customers.

Yes

What method(s) will you use to share the meessage with customers?

Comments

Please review the information you have provided above. A LifeShare of Oklahoma representative will follow-up with you within a week of receipt to discuss tailoring a program for your specific workplace