“Just Be Ready. Prepare Together.”Emergency Preparedness Campaign.
Public Health Request Form
Name:Agency:
Address for Delivery: City: CA Zip:
Telephone:Email:
List event where the materials will generally be distributed:
Small Quantities of 100 may be picked up from the EPRPoffice for the following materials:“Your Guide To Public Health Emergency Planning” and “Salvation Army Prep Guides”“X”—Indicates items no longer available.
All other requests will be deliveredBi Weekly on Monday’s and Wednesday’s
“Your Guide To Public Health Emergency Planning”[Wallet Cards]
(640 brochures/ case) / Order # case / Family Emergency Supplies Kits Brochure
(1200 brochures/case) / Order # case / Family Emergency Plan Brochure
(1200 brochures/case) / Order # case / Emergency Plan for People w/ Disabilities/Mobility (1200 brochures/case)
***limited #’s / Order # case / Children’s Emergency Preparedness Books
(78 Books/case) / Order
#Case / Salvation Army Prep Guide
(200 brochures per case) / Order
#case
Arabic / Arabic / Arabic / Arabic / Arabic / English
Armenian / Armenian / Armenian / Armenian / Armenian / Spanish / X
Chinese / Chinese / Chinese / Chinese / Chinese
English / English / English / English / English
Farsi / Farsi / Farsi / Farsi / Farsi
Khmer(Cambodian) / Khmer(Cambodian) / Khmer(Cambodian) / X / Khmer(Cambodian) / Khmer (Cambodian)
Korean / Korean / Korean / Korean / Korean
Russian / Russian / Russian / Russian / Russian
Spanish / Spanish / Spanish / Spanish / Spanish
Tagalog(Filipino) / Tagalog(Filipino) / Tagalog(Filipino) / Tagalog(Filipino) / Tagalog (Filipino)
Thai / Thai / Thai / Thai / Thai
Vietnamese / Vietnamese / Vietnamese / Vietnamese / Vietnamese
Please complete the order form and Fax toEPRP: Lawrence Lingat: (562) 906-0045 or email
To follow up on your order please call (562) 906-6127. Incomplete forms may delay delivery.
Name of Processor: Date order processed:
“Just Be Ready. Prepare Together.” Emergency Preparedness Campaign.
Public Health Request Form
Name:Agency:
Address for Delivery: City: CA Zip:
Telephone:Email:
List event where the materials will generally be distributed:
Small Quantities of 100 may be picked up from the EPRP office for the following materials:“Your Guide To Public Health Emergency Planning” and “Salvation Army Prep Guides”“X”—Indicates items no longer available.
All other requests will be delivered Bi Weekly on Monday’s and Wednesday’s
Emergency Preparedness Plastic Bags w/handles(1000 bags/case) / Order # Case / EmergencySurvival Program (ESP)
Family Steps to Survival
8.5” X 11”
(200 Booklets/case) / Order # Case / ESP
Activity Book
for Kids
8.5” X 11”
(140Booklets/case) / Order # Case / Order # Case / Emergency Preparedness Bookmarkers
(3000 markers/case)
*English on reverse side of every language / Order # Case / Order # Case / Order # Case
English / Spanish / English / English / Arabic
Spanish / Spanish / Armenian
Chinese
English
Farsi
Khmer(Cambodian) / X
Korean
Russian
Spanish
Tagalog(Filipino)
Thai
Vietnamese
Please complete the order form and Fax to EPRP: Lawrence Ling at: (562) 906-0045 or email
To follow up on your order please call (562) 906-6127. Incomplete forms may delay delivery.
Name of Processor: Date order processed:
1
Effective date July 3, 2008. Availabilities of items are subjected to change. Operators please take telephone number of caller for large requests of materials.