Responsible Tobacco Retailer Campaign--Materials Order Form
Please complete this form to request existing Responsible Tobacco Retailer campaign materials developed by the Center for Tobacco Prevention and Control (CTPC), within the Maryland Department of Health and Mental Hygiene.

Materials may be shipped via USPS or UPS. Special delivery instructions should be noted in the field "Special Delivery Instructions." Materials cannot be shipped to PO Boxes. Please provide the exact shipping address in the fields below.

Please allow 2-4 weeks for delivery.

Contact dhmh.notobaccosalestominors@maryland.gov with any questions.

Name/Title/Role *
(example: John Doe/Project Coordinator)
Your answer
Organization *
(example: Maryland Department of Health and Mental Hygiene)
Your answer
Street Address *
(example: 123 Anywhere St.)
Your answer
City *
(example: Town )
Your answer
State *
(example: MD)
Your answer
Zip Code *
(example: 12345)
Your answer
Special Delivery Instructions
Your answer
Phone Number *
(example: 123-456-7890)
Your answer
E-mail Address *
Your answer
Materials *
Select the product(s) and quantities you would like to order. Each toolkit contains one copy of the following items: Guidebook, Quick Guide, Law Sheets, Retailer Checklist, Window Cling, Sticker, Magnet, Pledge, and Poster. To view the materials visit: dhmh.maryland.gov/notobaccosalestominors/Pages/Educational%20Materials.aspx
No thanks
10
20
50
100
Other
Toolkits--temporarily out of stock
Quick Guides
Stickers
Magnets
If "Other" enter the items and quantities here
*Based on availability
Your answer
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