Materials Order Form

The Albuquerque Area Dental Support Center is a program of NAPPR, Inc. Our office creates culturally appropriate materials related to dental care. We are pleased to provide samples of our award-winning materials for use in your program at no charge.  Please fill out the form below for the materials you are requesting.  We'll send between 10 (posters/booklets) and 25 (brocures/postcards) of each piece you request.  Thank you!

Name:
Clinic Name:
Address:
City:
State:
ZIP:
E-mail:
Phone:
Fax:
I would like to check-out or order the following item(s):
Binder/Video to check out on page #
Binder/Video to check out on page #
Binder/Video to check out on page #
Binder/Video to check out on page #
Print materials to order For a healthy pregnancy card Lift the Lip brochure First Birthday card Taking Care of our children's teeth booklet Dental Emergency poster First Tooth poster First Tooth Rx pad A Healthy Mouth for Life brochure Children's Dental Health Month Materials "Babies are precious" poster "Children are precious" poster "Grandchildren are precious" poster Teen poster "Nothing is worse" poster (soccer) "Nothing is worse" poster (basketball) Girl postcard Boy postcard
Enter the characters in the image below into the textbox to the right of the image.