Save a Life Through Rescue 7
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Non Profit


Please note that the AED donation program is limited to Canadian nonprofit organizations only.


Facility requesting AED*
Contact Person and Title*
Mailing Address*
Phone*
Cell Phone*
Email*
Fax*

Reason for request* :

Describe unique needs i.e. at risk population, multi-use facility, fiscal restraints, etc.* :

Do you currently have an AED at this location?* :

If you have an AED, please explain why an additional AED is requested* :

What is the number of people served?* :
What age groups are served?*
Site for intended AED (site should be accessible during hours of operation)* :
Will this facility accept responsibility for all AED maintenance such as replacement of PAD-PAK (4 years expiration date) and AED accessories?* :
Name of person who will monitor the AED's readiness for use* :

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