Need for Defibrillation Programs Building A Program Successful Programs at Work Resource Directory Chain of Survival Home Other Resources American Heart Association American Red Cross Sudden Cardiac Arrest Association Philips Healthcare Additional Information For additional information, please complete the form below. (* 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 only Follow-up call Price quote to incorporate a public access program * Is your implementation project funded? Yes No Please note any additional comments below.   Success Stories More Information Philips | Privacy policy | Terms of use @2004-2008 Koninklijke Philips Electronics N.V. All rights reserved.