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* 1. Please enter your contact information below. The only items that will be listed on the website are your first name and last initial and your e-mail address (see question #2). You may have your city listed as well but that is optional (see question #3). The below information will be used for me to have to be able to get in contact with you. I will not be sharing this with anyone.

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* 2. Please list the e-mail address that you want listed on the website for donors to respond to. For security reasons, I recommend using an e-mail that DOES NOT contain your last name in any way. A suggestion would be to create a free e-mail account using Gmail or Yahoo. Another recommendation would be to create an email using your state, city or county such as 'ohiosafechapter@gmail.com'. Please list it in the box below.

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* 3. In addition, you may have your city listed in your posting on our website. Please check the box below if you would like your city listed.

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* 4. Are you under the age of 18? If you are under the age of 18, I will need parental consent in order to open your chapter. Please list your parent's name(s) and phone number in the comments section below.

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* 5. Please indicate what items you would like listed that you are willing to accept. Please check all that apply. YOU MUST AT LEAST CHOOSE NEW AND GENTLY USED STUFFED ANIMALS. You can change these choices later by sending me an e-mail if you would like items taken off or added on.

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* 6. Lastly, if there is anything additional you would like listed about your chapter, please list it here and we can talk about adding it as a comment in your chapter listing.

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