I would like to request a presentation/ training session:]
4
If yes, please indicate requested date:
5
Additional comments:
Materials Request
6
Safe Health Flyer Please fill-in the desired quantity for each language. Click to view
English:
Spanish:
Laotian:
Cambodian:
7
Safe Health Poster Please fill-in the desired quantity for each language. Click to view
English:
Spanish:
Vietnamese:
Laotian:
Cambodian:
8
Protect the Health of Your Family Please fill-in the desired quantity. Click to view
Spanish only:
9
Prevent a Family Tragedy Please fill-in the desired quantity. Click to view
Spanish flyer version:
Spanish poster version:
10
A Healthy Family is a Happy Family Please fill-in the desired quantity.
Vietnamese only:
By clicking "Submit" you can send this form electronically. As an alternative you can also print this form and mail or fax your request to the following:
Safe Healthcare Project 1725 West 17th Street Room 120M Santa Ana, CA 92706 (714) 834-8775 (714) 834-8051 Fax
