School/Early Childhood Program Order Form

Date: Organization:
Name: Address:
City: State:   Zip:
Phone: Fax:

Please order the exact quantities sufficient for a three-month period English Spanish
Record Cards Pink USIR (cards may be ordered individually) Due to increased
demand, your USIR order will be adjusted as necessary.
 
Schedule Cards Adolescent
Childhood
Childhood 8.5 x 11
Posters Back to School Imm Requirements Poster 11 x 17  
Preteen Doctor Visit 12 x 20
Got Vaxed Poster Teenagers 14 x 20  
Got Vaxed Poster Question Mark 14 x 20  
Vaccinate Before You Graduate 11 x 17  
Brochures A Guide for Parents about USIIS
Hepatitis A What You Should Know
Got Vaxed Adolescent
Preteen Doctor Visit
Protect Children by Protecting Yourself
The Utah School Immunization Rule
Vaccinate Before You Graduate
Your Child & Vaccine Safety
Tearpads VFC Information Tearpad double-sided English/Spanish  
Please verify your order by entering the random letters (case sensitive) displayed in this image:

Contact Tammy Gresham with any questions (801) 538-9450. Include exact quantities sufficient for a three-month period. Due to limited inventory, your order may be adjusted.
PLEASE ALLOW 1-2 WEEKS FOR DELIVERY