Postcards to Doctors: Request Form

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Fill out this form in order to receive addresses to send your postcards to reach medical providers in your home state.

This is for addresses only. To receive postcards, you'll need to order them at our Zazzle store here: https://www.zazzle.com/collections/postcards_to_doctors-119079782369504455.

Keep in mind that Unrest CME is currently certified in the United States only.

Please only request as many addresses as you need.

Email *

How many medical providers' addresses would you like to receive? *

Other:

Are you planning on having a postcard party or enlisting others to help?

Yes

Not sure yet

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Please enter your first name *

Please enter your last name *

Enter your street address *

Apt. or Unit # (optional)

City *

Please select the area where you live. *

Please enter your zip code. *

I promise to replicate the required wording on each postcard. I understand I can add my own, personal message after I have replicated the required wording. *

Yes, I promise to do so.

No, I can't promise that.

OPTIONAL: We will be sending periodic updates on the Postcards to Doctors campaign. If you'd like to hear about these updates, please add your email address below. We promise not to spam you with information and we will not add your name to our general mailing list.

A copy of your responses will be emailed to the address you provided.

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