To request to receive Free KIZIK Shoes from Kizik Design, LLC, please complete this form so we can best understand your needs. Please note that if you do not complete this form, you will not be considered. The recipient(s) will be selected by Kizik in its sole discretion, based on perceived need and merit. WE ARE ONLY DONATING 1000 PAIRS OF KIZIK HANDS-FREE SHOES SO, UNFORTUNATELY, NOT ALL REQUESTS WILL BE FULFILLED. Please note that this form closes on 4/24/20 at 11:59pm MT. The selected recipient(s) will be contacted by 5/1/20 to coordinate delivery. Not all sizes or styles are eligible. The sizes and styles will be selected by Kizik in its sole discretion. Shoes are final sale and not eligible for return or exchange. Offer valid within the United States only, to healthcare workers and organizations affected by COVID-19. Void where prohibited. Offer not available to persons under the age of 18. Offer may not be combined with other offers or promotions. No purchase necessary. Purchase does not affect the likelihood of being selected. The selected recipient(s) is/are responsible for any appliable taxes. No representation or warranty is made regarding the transmission of COVID-19.