* 1. First and Last Name
Physical Address (where the resources should be sent, cannot mail to a po box)

* 2. Email Address

* 3. Select your agency (choose all that apply)

* 4. Select the following Bright Futures Resources you would like to receive. (Please keep in mind that supplies are limited, so you may not receive all of the materials requested.)

Thank you for your request. Please allow 10 business days for delivery of resources.
Once you receive the resources, you can watch the videos and then complete the online evaluation/post-test.