Questions marked with an asterisk (*) are mandatory.

1	* Please provide the following information to ensure that our records are current. Name of Club City State Zip Code School Club President Email

2	* Your Contact Information Name Email Telephone Role in Club

3	* Which grade levels does this club include? (Check all that apply.) Grades K-3 Grades 4-5 Grade 6 Grade 7 Grade 8 Grade 9 Grades 10-12 College

4	* Which of the following best describes your club? A Red Cross Club that is specifically identified as a "Red Cross Club." Club members serve as officers, hold regular meetings and participate in Red Cross service projects. A Service/Project Club that operates within another club and uses a title other than "Red Cross Club." Members complete service projects for the Red Cross and for other service organizations.

5	* Please provide the name of the sponsoring Red Cross Chapter, Blood Region or Armed Forces Emergency Services station and contact information for the person who serves as your primary contact. Red Cross Unit Name of Primary Contact Title Telephone Number E-mail Address

6	How many members are currently in your club?

7	In what year was your club founded?

8	* Is the primary support for your club a school, a Red Cross chapter, or another organization? A school A Red Cross chapter, blood region or station Another organization