STD Awareness Materials Order Form

Must be a Minnesota-based organization/resident in order to receive supplies.

Please complete the form below to submit to Roy Nelson. You can also contact Roy via e-mail or by calling (651) 201-4027.

Contact Information

Name(s)
Organization
Address
City
State
Zip
Phone
Fax
E-mail
Agency Web site

Posters
These posters are 18" x 24."
(Click on image for a larger view.)
Number requested
Limit 10 per title.

Don't Wait 'til it Hurts (bees)

don't wait til it hurts with bees

Don't Wait 'til it Hurts (razors)

don't wait til it hurts poster with razors

Don't Wait 'til it Hurts (matches)

don't wait til it hurts poster with matches

To prevent abuse of this form, please type the following letters/numbers BEU3X into the field below. Thank you.
required


Please PRINT this form as a confirmation prior to pressing "Submit Order." Thank you.



If you have technical difficulties with this order form, contact Roy Nelson at MDH by calling (651) 201-4027, Fax: (651) 201-4000, or via e-mail.

Last Modified: 23-Apr-2014 01:47:53 pm