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Immunization Hotline
SCHOOLS RESOURCE ORDER FORM

Name:
Organization:
Address:
City:

Date:
Phone:
Fax:
State:   Zip:

Please order the number of packages needed: English Spanish
Record Cards Pink USIR (250)  
Schedule Cards Adolescent (100)
Childhood (100)
Childhood 8.5 x 11 (50)
Other Materials Immunization Guide Book (Redbook) 2009-2010
(Limit 2)		  
Posters Preteen Doctor Visit 12 x 20
Vaccinate Before You Graduate 11 x 17  
Brochures A Guide for Parents about USIIS (100)
Hepatitis A What You Should Know (50)
Hepatitis B Stop the Spread (50)
Got Vaxed Adolescent (100)
Preteen Doctor Visit (100)
Protect Children by Protecting Yourself (100)
Questions & Answers (25)
The Utah School Immunization Rule (100)
Vaccinate Before You Graduate (100)
Your Child & Vaccine Safety (50)
Tearpads VFC Information Tearpad (English and Spanish
combined) (50)		  
Please verify your order by entering the random letters displayed in this image:
Contact Lisa Young with any questions (801) 538-9101 or email

Include quantities that will be sufficient for a three month period.

PLEASE ALLOW 2-3 WEEKS FOR DELIVERY




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