Contact Information

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* 1. Organization Name

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* 2. Contact Name

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* 3. Mailing Address (Street Address, City, State, Zip Code)

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* 5. Phone Number

Brochure Selection

Brochure images can be found here:
1. Prepare to Prevent Diabetes Brochure
2. Ohio Over Hypertension Brochure
3. Combined Prepare to Prevent Diabetes & Ohio Over Hypertension Brochure

Please indicate below the quantity you would like to order for each brochure option.
Note: All items are packaged in groups of 50. Your order must be a multiple of 50 (e.g., 50, 100, 150, etc)

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* 6. Prepare to Prevent Diabetes Brochure

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* 7. Ohio Over Hypertension Brochure

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* 8. Combined Prepare to Prevent Diabetes and Ohio Over Hypertension Brochure

Stroke 'BE FAST' Magnets

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* 9. ODH 'BE FAST' Magnets

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* 10. Please briefly describe how you intend to use the prediabetes/hypertension brochure(s) and/or the stroke magnets?

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