Vaccines for Children Product Order Form

First Name:

Last Name:

Local Health Dept.:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

E-Mail:

Please indicate the materials you would like to order below.

Materials Available:

English posters (10 per order)

Spanish posters (10 per order)

Bilingual tear pads (English facing forward; 5 pads of 25 tear sheets)

Bilingual tear pads (Spanish facing forward; 5 pads of 25 tear sheets)

If you require additional copies of the materials, please explain here:

How did you learn of NACCHO’s Vaccines for Children campaign? (Check all that apply):

NACCHO website

Twitter

NACCHO Connect

NACCHO Dispatch

NACCHO's Infectious Disease/Immunization Newsletter

Email from NACCHO staff

Health department colleague

CDC

Sanofi-Pasteur

Public health partner organization

Other

Orders will be processed within 48–72 hours. Order confirmation will be sent when processed.