Order Materials Form

Name*

First Last

Address/Billing Address*

Street Address Address Line 2 City ZIP Code

State

Ship to the billing address?*

Yes
No

Shipping Address if Different from Above*

Street Address Address Line 2 City ZIP Code

State

Your Washington State County (i.e. Snohomish, Spokane, Clark)*

Phone*

Email*

Yuk Pak only

If you are NOT ordering other materials, check Yes. The Yuk Pak includes: a Mr. Yuk magnet, 2 sheets of Mr. Yuk stickers, Mr. Yuk First Aid Tips wallet card, and a current Seasonal Health Alert. TO PROCEED TO ORDER OTHER MATERIALS, check the NO box.

Yes
No

Name of organization that you are ordering materials for (write NONE if not applicable)*

Are you with a non-profit organization?*

Yes
No

To order materials, please choose from one of the following:*

Personal Home/Family
Local Health Jurisdiction
Hospitals and Primary Care Clinics
Schools (Preschool-High School)
Community Organizations

YUK PAK

YUK PAK (one)

The Yuk Pak includes: a Mr. Yuk magnet, 2 sheets of Mr. Yuk stickers, Mr. Yuk First Aid Tips wallet card, and a current Seasonal Health Alert.

PROFESSIONAL/ORGANIZATIONAL USE - Mr. Yuk Stickers (10 stickers per sheet)

Price: $0.00

PROFESSIONAL/ORGANIZATIONAL USE - Spanish Mr. Yuk Stickers (10 stickers per sheet)

Price: $0.00

PROFESSIONAL/ORGANIZATIONAL USE - Mr. Yuk Magnet - 1.75 inch

Price: $0.00

Quantities limited to 25

PROFESSIONAL/ORGANIZATIONAL USE - Mr. Yuk Magnet - 4 inch

Price: $0.00

Quantities limited to 25

PROFESSIONAL/ORGANIZATIONAL USE - Mr. Yuk First Aid Card

Price: $0.00

Wallet-sized folding first aid card with tips about what to do in case of a poisoning or toxic exposure.

PROFESSIONAL/ORGANIZATIONAL USE - Spanish Mr. Yuk First Aid Card

Price: $0.00

Wallet-sized folding first aid card with tips about what to do in case of a poisoning or toxic exposure.

If you need more than the maximum quantities listed, please describe the event or class, what quantities you would like, and we will contact you at the phone number you provided.