ORDER FORM “PROTECT YOUR FAMILY FROM MEASLES” DVD and “THINK MEASLES” POSTER Name: Contact Person: Address: Phone: Email: Resource Quantity* DVD: Protect Your Family From Measles [contains PSA and Parent Story and Expert Interview] ___ Please check to order ONE copy of the DVD [Limit 1 DVD per organization] Please indicate the number of each poster requested. ___ English “Think Measles” Poster ___ Somali ___ Oromo ___ Amharic [Limit 5 per language per organization] *Due to a limited number of DVDs and posters, we are only able to offer one DVD per organization and 5 posters per language per organization. Please complete and either fax or email this order form to: Maggie Kenyon‐Schultz Minnesota Department of Health Email: margaret.kenyon‐schultz@state.mn.us