Order Form: Let's Talk About PrEP! Kit

Planned Parenthood is partnering with Greater Than AIDS to provide select health centers with a FREE community toolkit about PrEP, the pill to prevent HIV. The informational materials are available in English and Spanish.

Each English-language kit includes:

- (150) brochures
- (500) palm cards
- (5) 11x17'' posters
- (10) buttons

Each Spanish-language kit includes:

- (100) brochures
- (250) palm cards
- (2) 11x17'' posters

Please fill out your information by no later than Friday, May 4, 2018, in order to receive a kit. Thank you!

1.Please indicate how many English-language Let's Talk About PrEP! kits you would like.
2.Please indicate how many Spanish-language Let's Talk About PrEP! kits you would like.
3.First name:(Required.)
4.Last name:(Required.)
5.Title:
6.Organization:
7.Email address:(Required.)
8.Phone number:(Required.)
9.Street address (NOTE -  We cannot ship to P.O. Boxes):(Required.)
10.Apt/Suite #:
11.City:(Required.)
12.State:(Required.)
13.ZIP code:(Required.)
14.Questions or comments? We'd love to hear how you're planning to use the kit!
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