Mens Changing Table Interest Form
1.
Organization or Business Name
2.
Organization or Business Address
3.
Name of person completing this form
4.
Phone number
5.
Email address
6.
How many public restrooms are at your facility? Please include the number of each restrooms that are designated as "Mens," "Womens," or "Family Restrooms."
7.
Will this changing table be installed in a restroom that is designated as "Mens?"
Yes
No
8.
Do you have the ability or capacity to install the changing table or have someone install it for you in a mens' only restroom?
Yes
No
Current Progress,
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