Need for Defibrillation Programs Building A Program Defibrillation Program Tool Kit Successful Programs at Work Resource Directory Chain of Survival Home Other Resources American Heart Association American Red Cross Sudden Cardiac Arrest Association Philips Medical Systems Championing Early Defibrillation in Your Community Video To order your one "FREE" copy of the "Championing Early Defibrillation in Your Community" DVD, please complete this form. (* required fields) *First Name:     *Last Name:     Position/Title:  Organization:  *Address:  *City:    *State:    *Zip:      *Phone:    *Email:    * What has heightened your interest in community early defibrillation? Media Coverage Advertisement Newspaper/Journal Article Web Personal Connection Other * Are you aware of existing AED programs (or AED use) in your community? If yes, please note location: I am unaware of any local AED programs Businesses Municipal Offices/Buildings Healthcare Facilities Other * Is your community considering an early defibrillation program? If so, please note the timeframe: Urgent 0-6 Months 6-12 Months 12+ Months Unsure No * What locations are you considering? Home Use Emergency Services Houses of Worship Libraries Municipal Buildings Office Buildings Public Areas Schools Other * What form of follow-up would you like? Literature and DVD only Follow-up call after receipt of DVD Price quote to incorporate a public access program * Is your implementation project funded? Yes No   Success Stories More Information Philips | Privacy policy | Terms of use @2004-2008 Koninklijke Philips Electronics N.V. All rights reserved.