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 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.