Today is For Me. Materials Order Form
Today is For Me. is a health campaign designed specifically for individuals seeking information on staying healthy before, during, and after pregnancy. These materials include science-based information about how substances such as alcohol, marijuana, and tobacco affect the body, mind, and overall health.

Order the materials below to share in your community!
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Email *
Your Name *
Your Phone Number *
Organization Name *
Organization Street Address *
Organization Town/City *
  Organization Zip Code *
Please select the amount of Today Is For Me. Rack Cards (English) you wish to have sent to you from the list below:
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25
50
75
100
Marijuana/Alcohol Rack Card
Tobacco Rack Card
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Please select the amount of Today Is For Me. Perinatal Health Posters (English) you wish to have sent to you from the list below:
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5
10
25
8.5" x 11"
11" x 17"
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Please select the amount of Today Is For Me. Toolkits for Healthcare Professionals you wish to have sent to you from the list below: 
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Please select how you would like to receive your materials from the list below: *
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