THE TAILOR SHOP - PERSONAL MASK REQUEST FORM
This is a service being provided to community members in and around Ludington, Michigan. As such requests received will be prioritized to provide personal protection masks to our community first. Please understand that submitting a request form is not a guarantee that you will receive the masks requested. While we will work tirelessly to provide as many hand made masks as we can, we may be limited by the amount of resources donated to this cause. If you live in or around Ludington, MI and you would like to request personal protection masks, please fill out the form below and we will be in touch when we have filled your request.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you or a member of your household work in the medical field or work as first responders serving our community?
*
YES
NO
Are you or a member of your household an essential worker or still required to work during the COVID 19 pandemic?
*
YES
NO
Are you or a member of your household at high risk (over the age of 60, immuno-compromised, pregnant, etc.) if exposed to the COVID 19 virus?
*
YES
NO
How many people live in your household and need a mask?
*
NOTE: One mask per household member. All masks are one size fits most adults
How would you like to receive your mask?
Delivered to my home within Ludington, MI City Limits
Mailed to my address outside of Ludington, MI City Limits
Submit
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