Membership Application Form

Safe Kids Yuma County

Membership Application Form

Please fill out the following and then check all that you are interested in:

First Name
Last Name
Title\Position
Organization Name
Division
Mailing Address
City
State
Zip Code
Work phone
Cell Phone
Home Phone
Email Address
Check if we may we list your organization as a member?
Bike Safety
Car Seat Program
Water Safety
Burns & smoke detectors
Pedestrian Safety
Nat. Safe Kids Week
Firearm safety
Public Policy
Membership & Awards
Fundraising/donations
Media & P.R.
Statistics & Evaluations
Yes, I am able to meet at noon on last Thurs. of month.
Interested in speakers bureau
I am able to help out on special events.
Suggestions/comments

Remember... SAFE KIDS Are NO Accident!

Get a better understanding of what Safe Kids is by clicking on the logo to the left. There are links to safety information, fact sheets, statistics, coloring pages for kids, and other great materials to help educate your families on how to stay safe!

Also follow us on MySpace, Facebook and Twitter for live updates and current events by clicking on the icons above!