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Congenital Heart Defect Awareness Week
February 7-14, 2013 

An international coalition of families, individuals, non-profit organizations, support groups, and health professionals participate in a campaign to increase public awareness of Congenital Heart Defects and Childhood Heart Disease.

CHD Week Volunteer Proclamations Participants Calendar

If you or your organization are already at work planning CHD Awareness Week activities, please submit this form to let us know about your plans!. We will include your event in our online calendar, and will add the name/names of the organizations you represent in the CHD Awareness Week section of our site. 

*Please be specific about what type of event you are planning

Note: if you are a Healthcare Professional, please click here to use the professional signup form.

 CHD Week Registration Form

Please enter your contact information
Except as described under "Permission", this information will not be shared.
Be sure to read our privacy statement.
First Name
Last Name
Organization
(Optional)
Mailing Address
City
State/Province 
Zip or Postal Code 
Country
Daytime Phone
Evening Phone  (Optional)
Email Address
(enter "none" if none)
Are you a
C.H.I.N. Member?		 Yes
No* 
 
* Please note that membership is not
required to participate in CHD Week events

Are you already working on CHD Week 2013?
Please check
all that apply

***Bloggers: please enter the URL of your blog where it says "Other"		 I am currently a State Coordinator
Event Coordinator
    with Hospital Participation
 
I am working on
State Proclamation Signing
Local Proclamation Signing
Fund Raising
Raising Awareness in the Community
 
Other:
Has a Date and Location been set for your event or
Proclamation Signing?		 No
Yes! (Please indicate where and when)
 
What hospitals, support groups, and/or organizations are participating?
 
Do you have corporate or private sponsors for your events? No
Yes! (Please list below)

Please check here if we can recognize
your sponsors on our site and in our
newsletters

Permission

I hereby grant  permission to C.H.I.N.
to publish my name and email address
on the web site .
(We will not release any other information without your permission.)
Please do not share my name or email but contact me privately

Comments and Feedback (Optional)

***Bloggers- please enter the name and URL for your blog page here!

 
    
 
Please report problems with this form to <sysadmin@tchin.org>
   

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Disclaimer: The contents of this site are presented for informational purposes only, and should not be substituted for professional advice. Always consult your (child's) physicians with your questions and concerns. Created and maintained by Mona Barmash and Uwe Baemayr for The Congenital Heart Information Network. Exempt organization under Section 501(c)3 Copyright ©1996 - 2012 C.H.I.N. All rights reserved TX4-390-685