Postcards to Doctors: Request Form
Fill out this form in order to receive both postcards and addresses for clinicians from your area. Keep in mind that Unrest CME is currently certified in the United States only. Please only request as many postcards as you need.
Email address *
How many postcards would you like to receive?
How many doctors' addresses would you like to receive at this time?
Are you planning on having a postcard party or enlisting others to help?
Please enter your first name *
Your answer
Please enter your last name *
Your answer
Enter your street address *
Your answer
Apt. or Unit # (optional)
Your answer
City *
Your answer
Please select the area where you live. *
Please enter your zip code. *
Your answer
I promise to replicate the required wording on each postcard. I understand I can add my own, personal message after I have replicated the required wording. *
OPTIONAL: We will be sending periodic updates on the Postcards to Doctors campaign. If you'd like to hear about these updates, please add your email address below. We promise not to spam you with information and we will not add your name to our general mailing list.
Your answer
A copy of your responses will be emailed to the address you provided.
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