Department of Health
Department
of Health
PUBLICATION REQUEST FORM
The New York State Department of Health offers limited
quantities of free educational materials to New York State
residents and organizations.
? No more than 10 different publications may be ordered.
? You may order up to 200 copies of each (10 copies of
posters) or provide details on why more are needed.
? For fastest delivery, please list items in numerical order
by code number. These orders will be processed first.
? Bulk orders cannot be delivered to post office
box numbers.
PUBLICATION TITLE
Complete and email this form to
OGS.SM.GDC@OGS.
PUBLICATION
NUMBER
LANGUAGE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
MAILING INFORMATION
NAME
ORGANIZATION (IF APPLICABLE)
STREET ADDRESS
CITY, STATE, ZIP CODE
PHONE NUMBER
DATE
QUANTITY
................
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