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Congenital Heart Defect Awareness Week
February 7-14, 2014 

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 you allow under "Permission" below, this information will not be shared.
Be sure to read our privacy statement
First Name
Last Name
Mailing Address
Zip or Postal Code 
Daytime Phone
Evening Phone  (Optional)
Email Address
(enter "none" if none)

Are you a
C.H.I.N. Member?
* Please note that membership is not
   required to participate in CHD Week events

Are you already working on CHD Week 2014?

Please check
all that apply

Bloggers: please enter the URL of your blog where it says "Other"
Event Coordinator
with Hospital Participation
I am working on
State Proclamation Signing
Local Proclamation Signing
Fundraising for group/organization:

Raising Awareness in the Community
Has a Date and Location been set for your event or
Proclamation Signing?
Yes! (Please include date/location/time)

What hospitals, support groups, foundations, and/or organizations
are participating?

Is information about your event posted on a website or social network? No
Yes! Please enter URL or event info

Do you have corporate or private sponsors for your events? No
(Please list below)

Please check here if we can recognize
    your sponsors on our site and in our
I would like to learn more about: Fundraising for C.H.I.N.
Getting local publicity
Arranging a proclamation ceremony with
      elected official(s)
Finding others in my city/town


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 instead contact me privately.

Comments and Feedback (Optional)

Please report problems with this form to <>


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