Cannabis and Pregnancy Resource request

Thank you for attending the recent launch of DEN's new resource, Cannabis and Pregnancy. The resource addresses cannabis use with pregnant women. As mentioned at the launch, hardcopies of the resource and an instructional video are available.

Please fill out your details below and the resources and/or video details will be forwarded to you.

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* 1. Please enter your contact details

Name *

Company *

Address *

Address 2

City/Town *

State *

Postal Code *

Email Address *

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* 2. I would like to receive a link to the Cannabis and Pregnancy instructional video

Yes

No

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* 3. I would like to receive hard copies of the resource

Yes

No

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* 4. Number of hard copies of the Worker resource

1

5

10

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* 5. Number of hard copies of the Client/Patient resource

10

20

50

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* 6. I would like to hear more about the great training, education and resource offerings from DEN via the monthly newsletter, The Connection.

Yes

No