Health Fair Materials Request Form 2013

Health Fair Materials Request Form 2013
Thank you for your interest in the American Heart Association!
We are happy to provide you with our standard health fair kit. We are limited in the amount of free materials that we are able to provide for your event. If your organization needs a large quantity of materials, we will provide you with a Krames Patient Education catalog for ordering. You can contact Krames at 800-333-3032 or visit their Web site at www.krames.com.
Please complete and return form to the American Heart Association office below. If at all possible, requests should be made 3 to 4 weeks in advance of the event.We’re sorry, but we are not able to send a representative to your event due to our limited resources!
Contact Name:
Organization Name:
Organization Type:
Street Address:
(We cannot ship to a P.O. Box)
City:
County:
State:
Zip Code:
Day time phone, including area code:
E-mail:
Date of Event:
Month Day Year
# attendees expected:
....
Check here if you would like to request Spanish materials
Enter the letters as shown.*
Should be Empty: