KTPC Print Materials Request Form

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If you would like the Kentucky Tobacco Prevention & Cessation Program (KTPC) to mail promotional materials to your organization, please complete the following form.

All orders are subject to availability. If we are unable to fill your order as requested or if there will be delays on our side, we will contact you at the email or phone number you share below.

There is no cost for you to have us mail promotional materials to you. However, KTPC reserves the right to refuse any materials request. If we will not be able to fill your request, we will notify you in an email.

If you would like to request a greater quantity of an item than the form allows (e.g., hundreds of posters), please email Ky.TobaccoFree@ky.gov with an explanation. We will either fill the request or send you a print-ready file you can take to your printer.

If you have questions about this process or about your order, please contact KY.TobaccoFree@ky.gov.

Contact Person Name *

Organization Name *

Organization Type *

Local Health Department

Hospital

Dentist

Medical Clinic

Other Health Care Provider

School

Recovery Community Center

Other:

Required

Mailing Address (Street Address) *

City *

State *

Zip Code *

Phone Number *

Email Address *

I would like to receive the Tobacco Prevention & Cessation Program's monthly newsletter at the email address listed above. (This response will not affect your ability to receive print materials.) *

Yes

School Signage

Materials to promote tobacco-free K through 12 school campus policies as mandated by KRS 158.149.

Property Entrance Sign - Out of Stock

11" x 12" sign made from 0.40 aluminum. One sided with four pre-drilled holes. To be posted at entrance to school campus. No more than two per school. Please indicate the number requested.

Donated by the Foundation for a Healthy Kentucky, the Kentucky Medical Association and the Kentucky Foundation for Medical Care.

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Outdoor Facility Sign - Out of Stock

7" x 10" sign made from 0.40 aluminum. One sided with two pre-drilled holes. To be posted on fencing at athletic facility or playground entrance. Please indicate the number requested.

Donated by the Foundation for a Healthy Kentucky, the Kentucky Medical Association and the Kentucky Foundation for Medical Care.

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Window Sticker

5" x 7" sticker to be adhered to school building doors or school bus doors/windows. Please enter the number requested.

Donated by the Foundation for a Healthy Kentucky, the Kentucky Medical Association and the Kentucky Foundation for Medical Care.

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Banner

One-sided vinyl banner, estimated at 2" by 6", with grommets in each corner. Please enter the number requested.

Notify me if this item becomes available.

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Materials for Retailers Who Sell Tobacco

Tobacco 21 ("T21") is a federal and state law requiring individuals to be at least 21-years old in order to purchase tobacco products.

The Synar Program in the Department for Behavioral Health, Developmental and Intellectual Disabilities (BHDID) and the Kentucky Department of Alcoholic Beverage Control in the Public Protection Cabinet help enforce this law and educate retailers through the Tobacco Retailer Underage Sales Training (TRUST).

For more information, please contact Synar Coordinator Steve Cambron.

T21 Packet

The purpose of the T21 packet is for coalitions, health departments and other community leaders to promote Kentucky’s Tobacco Retailer Underage Sales Training (TRUST) and educate tobacco retailers on how to best prevent access to tobacco products by young people.

Each packet includes:

- One TRUST brochure

- One 6 x 8.5 window cling

- Four 3 x 4 point-of-sale stickers

- Ten buttons

- One Tobacco 21 FAQ document

- One Kentucky Tobacco Sales Acknowledgement form

and

- One letter of explanation from the BHDID commissioner.

These packets are provided by the state Synar Program. If you would like more than 20 packets, please email Synar Coordinator Steve Cambron at Steve.Cambron@ky.gov.

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Quit Now Kentucky Materials

Materials to promote 1-800-QUIT-NOW and QuitNowKentucky.org. (Quit Now Kentucky is our quitline for all ages.)

Quit Now Kentucky Referral Card

3.5'' x 2'' business cards, double-sided.

You may print your own referral cards by using the file available here: https://drive.google.com/file/d/1d6E84IZyGg8fZTsVx4e7xA5MZxSaykvD/view?usp=sharing

100

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400

500

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Quit Now Kentucky Referral Card in Spanish

3.5'' x 2'' business cards, double-sided.

You may print your own updated cards by using the file available here: https://drive.google.com/file/d/1JGO0hw2OpofPXl-8ah3ZKAc0h10JOLM0/view?usp=sharing

I will print these myself

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Quitters Always Win Referral Card

Temporarily Out of Stock

3.5'' x 2'' business cards, double-sided.

You may print your own referral cards by using the file available here: https://drive.google.com/file/d/137Y0SaeHZ_yGsP5mDj6eor1foxXmhdom/view?usp=sharing

Notify me when this is back in stock

Other:

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Kick Butts Referral Card

3.5'' x 2'' business cards, double-sided.

You may print your own referral cards by using the file available here: https://drive.google.com/file/d/1EeK2-bfZOb6MAwbh5J-rEUTDBPSBE-_i/view?usp=sharing

100

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500

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Quitting for Two (Pregnancy) Referral Card

3.5'' x 2'' business cards, double-sided.

You may print your own referral cards by using the file available here: https://drive.google.com/file/d/1oE89PDPDj8KU0na5nnVNzvC6pTw-WhhY/view?usp=sharing

100

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500

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Quit Now Kentucky Poster (Group Design)

11'' x 17'' poster on card stock, single-sided

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Quit Now Kentucky Poster (One-on-One Design)

11'' x 17'' poster on card stock, single-sided

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Quit Now Kentucky Poster (Pregnancy Design)

11'' x 17'' poster on card stock, single-sided

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Quit Now Kentucky Tri-fold Brochure

3.68'' x 8.5'' tri-fold brochure on glossy paper

Notify me if this item becomes available.

Other:

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Co-branded Quit Now Kentucky and My Life, My Quit Materials

Quit Now Kentucky AND My Life, My Quit "Rx Pads"

5.25'' x 4.25'' mock prescription pad with tear-off sheets printed with Quit Now Kentucky promotion on one side and My Life, My Quit promotion on the other side. These are not sticky notes.

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My Life, My Quit Materials

Materials to promote MyLifeMyQuit.com or texting "START MY QUIT" to 36072. (My Life, My Quit is the quitline for ages 17 and under.)

My Life, My Quit "Quit Vaping" Referral Card

3.5'' x 2'' business cards, double-sided

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500

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Vaping Clouded My Future Poster

11'' x 17'' poster on card stock, single-sided

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I Broke Up With My Vape Poster

11'' x 17'' poster on card stock, single-sided

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Vaping Wasn't Just A Trend Poster

11'' x 17'' poster on card stock, single-sided

Notify me when this is back in stock

Other:

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Self-Print Materials

The following materials are not available for ordering at this time but can be downloaded and printed.

Quit Now Kentucky Fact Sheet for General Audiences

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheet.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Pregnant or Postpartum Clients

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetPregnancy.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Behavioral Health Needs

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetBH.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Public Housing, Medicare, and Uninsured Audiences

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetPHA.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Young Adults

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetYA.pdf

I will print these myself

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Types of NRT (Audience: Public)

8.5'' x 11'' single-sided. Available at chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/NRTflyer.pdf

I will print these myself.

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The 5 Rs (Audience: Health Care Providers)

Available at https://bhwell.uky.edu/sites/default/files/2022-04/5Rs%20simple%20021622.pdf

I will print these myself.

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The 5 As (Audience: Health Care Providers)

Available at https://bhwell.uky.edu/sites/default/files/2022-04/5As%20simple%20021622.pdf

I will print these myself.

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Tailored Tobacco Treatment (Audience: Health Care Providers)

Available at https://bhwell.uky.edu/sites/default/files/2022-04/Pharmaco%203.0%20KP%20022522.pdf

I will print these myself.

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Tobacco Cessation & Recovery (Audience: Health Care Providers)

Available at https://bhwell.uky.edu/sites/default/files/2022-04/Tobacco%20Cessation%20and%20Recovery%20PMI.pdf

I will print these myself.

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Tobacco Treatment Reimbursement (Audience: Health Care Providers)

Available at https://bhwell.uky.edu/sites/default/files/2022-06/Tobacco%20Treatment%20Reimbursement%20Guide.pdf

I will print these myself.

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Questions (Optional)

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Comments (Optional)

Consider sharing ideas of other print materials that would be helpful to you in the future, information about whether you are requesting these for a specific event or on behalf of a local partner, etc. Please reference the file name wherever relevant.

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