Clean Air Services Interest Form

Philly Breathes Clean Air Services Interest Form — short version
We are trying to determine community interest in clean air services like building D.I.Y. air purifiers, testing how well your mask fits, taking or reading air quality data, and more.

Please let us know if you're interested, if you can support us in setting any of them up, or if you have/ know of any resources that might be helpful.

We're volunteer-run and community-funded. We appreciate your support!

Visit linktr.ee/PhillyBreathes for our mask request form, GoFundMe, social media, and other resources!
Mask Fit Tests
Are you interested in qualitative mask fit tests? They use a Saccharin (extremely sweet) or Bitrex (extremely bitter) solution that is spread into the air with a nebulizer.

YesNoOther
Are you interested in quantitative mask fit tests? They use a particle counting device, like a PortaCount Respirator Fit Tester.

Yes (We do not have one, but with enough interest we may get one if we have the funds)NoOther
D.I.Y. Air Purifier Workshops
Are you interested in workshops to build your own air purifier?

Yes, I am interested in building any kind of air purifier!Yes, a high-capacity purifier using box fans.Yes, a low-noise purifier using personal computer (PC) fans.NoOther
Your Information (Optional!)

Please provide your information if you'd like to receive email updates about workshops, or if you would like us to reach out to you.
Name & Pronouns

Name that you'd like to be referred asPronouns (optional)
Location (Zip code or street intersection works!)
Not required, but helpful for us to know :)
Contact Info (Email preferred, but feel free to leave a phone number, Instagram handle, or TikTok handle – wherever you are most reachable)
example@example.com or (123) 456-7890 or @example
Are you interested in volunteering any resources or services?

NoYes (Please specify. For example: language translation [including to ASL or plain language], graphic design, space to host workshops or services, access to a printer or CO2 monitor, woodworking tools, etc.)
Leave any other suggestions or requests here. Do you have any security or access needs? Any suggestions for places to host workshops/ services?
Should be Empty:

Philly Breathes Clean Air Services Interest Form — short version

Mask Fit Tests

D.I.Y. Air Purifier Workshops

Your Information (Optional!)