REQUEST First Name*Last Name*TitleArea/Country to be served*Type of organization*Organization NameProject ID (If applicable)Street Address*Address (continued)City*State*Zip Code*Phone Number*FaxWebsiteEmail* Shoe Sizes, Quantities and Gender*Please fill as follows: Male: X pairs, Sizes: X,X,X Female: X pairs, Sizes: X,X,XPurpose Statement*A brief description of how shoes will be distributed to ensure that the recipients are as described in Choose To Care, Inc. Mission Statement. Include name of responsible persons involved in this activity, past history of similar or other distribution activities and what will be achieved as a result of this project. This iframe contains the logic required to handle Ajax powered Gravity Forms.