Apply For A Mikey

The Mikey Network is committed to providing Portable Access Defibrillators in Schools, Recreation Centres, and other high-traffic public buildings and facilities across the GTA.

Do you think your location needs a Mikey? You can request a Mikey for your organization using our online application, or download the application as a PDF and send it through the mail.

Please note that The Mikey Network can only accommodate so many defibrillator requests. Once we receive your application, we will consider it carefully and contact you regarding the feasibility of placing a Mikey in your location, as well as an estimated time frame within which that can happen.

Applicant Information

Fields marked bold are required.

First Name: Please enter your first name.
Last Name: Please enter your last name.
Address: Please enter your address.
City: Please enter your city.
Province / State: Please enter your province or state.
Postal / Zip Code: Please enter your postal or zip code.
Country: Please enter your country.
Phone: Please enter your phone number.
E-Mail: Please enter your e-mail address.Invalid e-mail address!
Please enter a valid e-mail:
ex: yourname@network.com

Unit Information

Organization Type:
Public Organization Private Organization Charity Organization This field is required.
Name of Organization : Please enter a location.
Department,
Industry, or
Chairity #: A value is required.
Location #1: Please enter a location.
Location #2:
Location #3:
Location #4:

Summary

Please provide a brief summary of the aims and objectives of your organization. As a member of The Mikey Network list or outline the fundraising events, sponsorships & educational programs you are interested in organizing to further promote Mikey’s Mission.

Organization Summary A value is required.

Apply For A Mikey

Applicant Information

Unit Information

Summary

Mikey Defibrillators