Help Me Grow Alaska Materials Order Form

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Help Me Grow Alaska has updated our outreach materials which describe our program and services, including contact information to speak to our Family Support Specialists in our call center and information on how to refer a family for services and supports. We have brochures, rack cards, one-page description sheets (in both color and black and white) coloring sheets with our new illustrations on one side and description sheets on the other, labeled crayon packs and Alaskan versions of the CDC Milestone Moments booklets.

*For prescribing medical providers, we also have Partnership Access Line-Pediatric Alaska (PAL-PAK) Care Guides.

Thank you for ordering HMG-AK materials to share with your community. After receiving this order form, we will send out materials within 10 business days. If you have additional questions, please feel free to contact us at 833-464-2527 or contact@helpmegrowak.org.

First Name *

Last Name *

Organization *

I can pick up these resources in Anchorage

Yes

No, please ship to address below

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Mailing Street Address or P.O. Box Number *

City *

State *

Zip Code *

Phone Number *

E-mail Address *

ASQ Materials Kit for Developmental Screening

Other:

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PAL-PAK Care Guide (please state how many you would like)

HMG-AK Brochures

100

150

200

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HMG-AK Rack Cards

100

150

200

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HMG-AK Medical Provider Rack Cards

100

150

200

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HMG-AK One Page Flyers

100

150

200

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HMG-AK Coloring Sheets

100

150

200

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CDC Milestone Moments Booklets, Alaska Version

100

150

200

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CDC Milestones Moments Booklets in Spanish, CDC Version

100

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