1.What is the name, address, email, phone number and contact person of your organization?

2.How many kits are you requesting?

3.Please give as many details as to the who, what, where and when's that these kits will be distributed.

4.HFTH kits are assembled and are to be picked up in Geneva, NY. If you are unable to pick up your requested kits, please provide alternate method of receipt (i.e. you provide payment for them to be shipped).

5.A requirement of receiving HFTH kits and repeat orders, is to provide feedback via another survey, so we can improve upon our processes. Are you willing and able to provide this feedback?