PA 211 Promotional Materials Order Form
Use this form to get PA 211 posters, wallet cards/holders, and magnets shipped to your organization for free. These materials are available, free of change, to any public or private organization interested in promoting PA 211 to Pennsylvanians.

Please note that if you do not want any of a particular item, you should mark "None."

For questions about the materials, email info@uwp.org.
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Email *
Name of Contact Person:   *
Title of Contact Person:   *
Name of Organization: *
Street Address of Organization: *
City: *
State: *
Zip Code: *
Please describe the program that will distribute these materials: *
Please describe the target population(s) that your organization will distribute these materials to: *
How did you hear about PA 211? *
PA 211 Magnets *
This magnet is for handing out to individuals.
This magnet is for handing out to individuals.
Required
PA 211 Poster: Teen - Spanish *
This poster is for hanging in areas where people will see it.
This poster is for hanging in areas where people will see it.
Required
PA 211 Poster: Teen - English *
This poster is for hanging in areas where people will see it.
This poster is for hanging in areas where people will see it.
Required
PA 211 Poster: Mom & Child - English *
This poster is for hanging in areas where people will see it.
This poster is for hanging in areas where people will see it.
Required
PA 211 Poster: Grandmother & Teen - English *
This poster is for hanging in areas where people will see it.
This poster is for hanging in areas where people will see it.
Required
PA 211 Poster: Man - English *
This poster is for hanging in areas where people will see it.
This poster is for hanging in areas where people will see it.
Required
PA 211 Wallet Cards - English *
This wallet card is for handing out to individuals.
This wallet card is for handing out to individuals.
Required
PA 211 Wallet Cards - Spanish *
This wallet card is for handing out to individuals.
This wallet card is for handing out to individuals.
Required
Notes for your order: (optional)
A copy of your responses will be emailed to the address you provided.
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