Home » GFWC Request Form GFWC Request Form Thank you for your interest in learning more about Canine Companions for Independence®. Please complete the following form as completely as possible. A staff member will respond to your request within one week. If you have any questions please call 1-800-572-BARK (2275).Name* First Last Email* Address* Street 1 Street 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Phone number*Club, district, state* Yes, I would like to receive communications from Canine Companions®. I am interested in:* Canine Companions brochures Presentation by a puppy raiser Presentation by a graduate Working an information booth Volunteer opportunities Ways my club, district or state can support Canine Companions Additional information (event, number of people in attendance, location, date, etc.)
