My Special Aflac Duck® for Cancer

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Request Frequency

One time request

Recurring monthly request

My Special Aflac Duck with sickle cell accessories

My Special Aflac Duck® for Sickle Cell

Quantity

Request Frequency

One time request

Recurring monthly request

Your First Name *

Your Last Name *

Phone Number *

Email *

Title *

Unit *

I am a *

License Number (if applicable)

Organization Information

Organization Name *

EIN

Is your organization part of the Children's Miracle Network?

Is your organization part of the Children's Oncology Group?

Shipping Information

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country *

Additional Information

How did you hear about our program? *

Would you like to opt in to receive the quarterly Aflac Childhood Cancer newsletter?

Anything additional?

Support

Have a question about My Special Aflac Duck? Missing a feeling card? Need medical play accessories?

For help with your duck, please contact Sproutel:

Email: support@empathlabs.com
Toll Free within US: (833) 777-6885

If you are a medical professional, please use this form to request ducks for your hospital.

If you have a question about Aflac’s philanthropic efforts surrounding pediatric cancer and blood disorders, reach out to us at: ContactUs@AflacChildhoodCancer.org

Empath Labs Incs. DBA Sproutel
60 Valley St Ste 29
Providence, RI 02909

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