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!

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* 1. Please indicate how many English-language Let's Talk About PrEP! kits you would like.

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* 2. Please indicate how many Spanish-language Let's Talk About PrEP! kits you would like.

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* 3. First name:

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* 4. Last name:

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* 5. Title:

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* 6. Organization:

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* 7. Email address:

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* 8. Phone number:

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* 9. Street address (NOTE -  We cannot ship to P.O. Boxes):

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* 10. Apt/Suite #:

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* 11. City:

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* 12. State:

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* 13. ZIP code:

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* 14. Questions or comments? We'd love to hear how you're planning to use the kit!

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