Outreach Materials Request

First Name:
Last Name:
Organization:
Title:
Address:
City:
State:
Zip:
Phone:
Email:
Please add me to the Healthy Kids Mailing List (includes quarterly progress reports and invites to special events)
Please have a Field Coordinator contact me to schedule a visit or answer my questions.
Materials Requested:	Quantity Requested:
Brochure A color brochure describing how to apply, income chart, the different programs and guidance on who is eligible.
Leaflet A double sided leaflet that describes benefits, income chart and how to apply.
Poster (English) Full color poster that has a card holder attached for families to take information with them.
Poster (Spanish) Full color poster that has a card holder attached for families to take information with them.
Business cards with stand A small business card stand that can be placed at client windows and holds a small informational card for families to take with them.
Annual Report