Materials Request FormPlease fill out the form below to receive educational materials from the Indiana Poison Center.Orders will be processed within three business days. Please allow time for processing and shipping.For quantities over 200, please call (317) 962-2335.Name* First Last PhoneSchool / Company*Email* Date Needed* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reasons for Material* School Nurse Pharmacist Hospital EMS Health Fair Personal Use Law Enforcement Parent MD Office Fire Dpt. Talk Patient / Client Distribution OtherPoison Help Magnets*Poison Help Stickers*Wallet Card with Key Tag*IPC Pencils*Magnets "Dile a una amiga"*