TXENA Chapter W.H.A.L.E. Kit Request Form

TXENA Chapter W.H.A.L.E. Kit Request Form
Would you like to distribute W.H.A.L.E. Kits at an upcoming chapter event? Please use the link below to complete the JotForm to submit your request. The kits will be mailed to the requestor at the address provided on the form.

A kit consists of the following:
- 1 Information Sheet
- 1 W.H.A.L.E. Brochure
- 1 Child Identification Sticker
- 2 Window Clings
- 2 Car seat Stickers
For example: If you order 25 kits, you will receive – 1 information sheet, 25 brochures, 25 Child Identification Stickers, 50 window clings, 50 car seat stickers.
Chapter:
Person Requesting Kits:
Address where the kits are to be mailed (if event is shortly after Q2 in April, we will have the kits at the meeting for pickup.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number - For immediate inquiries regarding order
Please enter a valid phone number.Format: (000) 000-0000.
Anticipated Event - Please provide event name, location and date.
Select number of kits requested:
Note: Please requests kits in enough time to take into account mailing time via USPS.
After your event, please email a summary of how the kits were utilized to whale.project@txena.org. Additionally, if you have any photos from events where the kits were distributed, we would appreciate you sharing those as well.
Should be Empty: