NCDHM Poster Order Form (Members)

NCDHM Poster Order Form (Members only)
- Orders must be placed by Friday, February 2, 2024.
- Posters are distributed on a first-come, first-served basis to PDA members.
- Posters are free, but you will be charged a nominal shipping and handling fee for large orders.
Please complete the following information so that we may process your request. Questions? Email Zsofia Kandrot at zlk@padental.org. Thank you!
Name

First NameLast Name
ADA Number
Attention:
(if different from member's name)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Poster Quantity Requested:
Date materials are needed by:

MonthDayYear
Date
Promotion Type:

Mall EventSchool VisitOther
Promotion Sponsor:

District/Local SocietyIndividualBothOther
If you request more than 20 posters you will have to pay for shipping. You will receive a phone call or email from PDA to obtain your credit card information.
Should be Empty: