Educational Materials Order Form

Shipping Information

Name:

Shipping Address:

City and State:

Zip Code:

Phone Number:

Email Address:

Name of Your Organization (if applicable):

Describe Your Organization (ex: non-profit, hospital, etc.):

Event Information

If you are not ordering materials for an event, please skip this section.

Name of Your Event:

Date of Event:

Describe Your Event (ex: presentation, health fair, etc.):

County Location of Your Event:

Estimated Attendance:

Describe Your Audience:

Materials

Enter the desired quantity for each item in the boxes below. Up to 100 of each item are free. Item prices are included for amounts exceeding 100, in which case an invoice will be sent with the order (preview brochures; preview other materials).

Magnets ($0.05 each)

1-800-222-1222 Poison Help (English):

Spanish Magnets:

Telephone Labels ($0.02 each)

1-800-222-1222 Poison Help (English):

1-800-222-1222 Poison Help (Spanish):

Brochures ($0.08 each)

Could You Be Next? (General - English):

Could You Be Next? (General - Spanish):

New Mexico's Poisonous Plants:

New Mexico's Venomous Snakes:

Other

Children's Activity Books ($0.11 each):

Ask Me What I Learned Stickers (free):

1-800-222-1222 Poison Help Bookmarks ($0.02 each):

Digi Clean Cards ($0.02 each):

Comments: