Register your Community Screening Event

Community Screening Event Registration

Thank you for helping the most at-risk communities to get access to the screening events. Event ambassadors live and work in the community and help SALSAL with the heavy lifting of organizing and coordinating the event. If you’re a go-getter with community connections, and a willingness to volunteer your time for 4-6 months prior to the event
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you a healthcare provider?
Address of the Community Screening event

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there any phone number of the Screening event location?
Screening Event location Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Local Ambassador details:
Start Date of Community Screening Event and Start Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
End Date of Community Screening Event and End Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Any comments for SALSAL admin team to know in advance
e.g., video you want admin team to attach to email, any visuals of the event space, checklists, or any additional information you would like to be posted on website,/shared with volunteers
Any documents you want to upload for us to use for this event

Cancelof
All materials, presentations, and content shared through The Save A Leg, Save A Life Foundation (SALSAL) are the property of SALSAL. By submitting this form, you acknowledge and agree that these materials may not be reproduced, copied, or distributed without prior written consent from SALSAL.
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Community Screening Event Registration