APPLICATION FORM

    Please fill out the form below and we will contact you with your eligibility for an AED grant or discount.


    Estimate the total # of people in your immediate city/town/village/township:

    Does your agency/institution currently own an Automated External Defibrillator:

    and/or, I am looking to replace current AEDs

    CPR/AED training is mandatory to be eligible for this grant. Discounted training will be added to the cost unless proof of current CPR/AED certification is provided.
    Submitting this application in no way obligates me to participate.