Thank you for partnering with us and being willing to distribute our materials to your community. This form was created to request materials from the Michigan Department of Health and Human Services Cancer and Control Section for your organization to hand out. If you have any questions, please email us at MDHHS-WomensHealthPartner@Michigan.gov.

Question Title

* 1. What is the name of your organization?

Question Title

* 2. General Partnership Items
*these are items that can be easily passed out at events

Please select which documents you would like us to send to you. (please select up to 5 different items. If you would like to request more than 5 different items, please email MDHHS-WomensHealthPartner@Michigan.gov)

Question Title

* 3. Would you like 50 or 100 copies of the document you selected above?

Question Title

* 4. Display Items.
These items are best to post at a location, instead of distributing at an event or handed amongst visitors. We limit the number of the items below sent to you to five each.


Please choose which documents you would like us to send to you. (select all that apply)

Question Title

* 5. Please type in your first and last name

Question Title

* 6. Please insert your phone number

Question Title

* 8. Please type the address you would like the materials delievered to

( Privacy & Cookie Notice

T