Rideshare Safety Partition Giveaway

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Rideshare Safety Partition Giveaway

Rideshare Safety Partition wants to give back to the community. They will choose a family for a FREE vehicle safety partition. Use this form to submit your story as to why you feel this will positively impact your life. Deadline for submissions is August 28, 2024.

https://ridesharesafetypartition.com/

First & Last Name *

Email *

Zip Code (US only) *

Car Make *

Car Model *

Car Year *

Why should you be chosen for the free vehicle partition? How will this positively impact your life? *

I understand that my application will be reviewed by Rideshare Safety Partition and that if I am chosen, I will be contacted by email by September 10, 2024. I understand that I will have 7 days to respond, and if no response is provided, Rideshare Safety Partition will move to the runner-up until the giveaway is claimed and I will forfeit my claim to this item. I understand I will need to provide Rideshare Safety Partition my mailing address and phone number if I am chosen as the winner so the item may be shipped to me. *

Yes

I understand the National Council on Severe Autism (NCSA) is pursuing policy solutions for care necessary for physical safety and that my story may be used in part or in whole by NCSA in the pursuit of improvements to policy such as health coverage for safety items like this. (Choose one) *

I agree, and my name may be shared.

I agree, but I request identifying information such as name to be redacted (removed).

I understand if I am chosen, my first name, last initial, and state will be announced publicly. *

Yes

Submit

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