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Social Media Account Usernames
Shipping Address
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This is so we can send you an awesome Hemp T-shirt!
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First Name
City and State
Donor Selfie
Social Media Account
Why You Donated
None; DO NOT SHARE
Location of Donation
(Optional if selfie at location is included)
Date of Appointment
Contact Information of Donation Site
(Optional if selfie is included)
How Did You Hear About The Initiative
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We are tracking sources for a friendly competition. Please try to remember exactly how/where you heard about the initiative so they get credit
Have you donated before?
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Yes, but it's been more than 5 years
Why did you donate?
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Will you donate again?
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Undecided
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Do you want to be posted on our online wall of heroes?
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What is your age?
(Not required and will not be shared publicly, but would be helpful for us to tune in our messaging!)
PLEASE UPLOAD YOUR DONATION SELFIE HERE
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You can upload up to 2 files.
Please upload your donation selfie(s) (if applicable)
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Hello and thank you so much for helping to save some freaking lives! You are an amazing person and you should just know that. With your basic information below, we do ask that you participate by also submitting the following:
Selfie during donation, and the Name of the donation site
If no selfie, then please provide: Appt date and time Physical address of site contact info of donation site
UPDATE: Only shirt sizes remaining for this particular campaign are XL,XXL and XXXL
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Name
*
First
Last
Email
*
Phone Number
*
Social Media Account Usernames
Shipping Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
This is so we can send you an awesome Hemp T-shirt!
Permissions
*
First Name
City and State
Donor Selfie
Social Media Account
Why You Donated
None; DO NOT SHARE
Location of Donation
(Optional if selfie at location is included)
Date of Appointment
Contact Information of Donation Site
(Optional if selfie is included)
How Did You Hear About The Initiative
*
We are tracking sources for a friendly competition. Please try to remember exactly how/where you heard about the initiative so they get credit
Have you donated before?
Yes
No
Yes, but it's been more than 5 years
Why did you donate?
*
Will you donate again?
Yes
No
Undecided
Tell us about your donation experience?
Do you want to be posted on our online wall of heroes?
*
Yes
No
What is your age?
(Not required and will not be shared publicly, but would be helpful for us to tune in our messaging!)
PLEASE UPLOAD YOUR DONATION SELFIE HERE
Click or drag files to this area to upload.
You can upload up to 2 files.
Please upload your donation selfie(s) (if applicable)
Opt into our Newsletter?
Of Course!
No, I'd rather not
Submit
