Pinup Campaign Request Form

Pinup Campaign Request Form

Complete this form to request your free pinups! Cards ship in packs of 100. Please order only what is needed. We will make every effort to ship your pinups to arrive by your requested date.

Today's Date*

Number of Toolkits Requested*

Includes guide, promo poster, goal poster and wrap-up form.

1

2

3

4

Number of Pin Up Cards Requested*

100

200

300

400

Language: English, Spanish or a mix of both*

English

Spanish

Mix of both (Minimum quantity is 100 of each)

Date Kits are Needed*

School/Company Name*

First Name*

Last Name*

Email Address*

ex. johndoe@email.com

Street Address*

No P.O. boxes; ex. 1234 Main St

Street Address, Line 2

No P.O. boxes; ex. Apt #1

City*

ex. Minneapolis

State*

ex. MN

ZIP Code*

ex. 12345

Phone Number*

ex. 123-456-7890

Phone

NMDP Representative Name (if known)

Comments or Questions

Send me a copy of my responses

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