Responsible Tobacco Retailer Campaign--Materials Order Form
Please complete this form to request existing Responsible Tobacco Retailer campaign materials developed by the Center for Tobacco Prevention and Control (CTPC), within the Maryland Department of Health.

Materials may be shipped via USPS or UPS. Special delivery instructions should be noted in the field "Special Delivery Instructions." Materials cannot be shipped to PO Boxes. Please provide the exact shipping address in the fields below.

Please allow 2-4 weeks for delivery.

Contact mdh.notobaccosalestominors@maryland.gov with any questions.
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Name/Title/Role *
(example: John Doe/Project Coordinator)
Organization *
(example: Maryland Department of Health and Mental Hygiene)
Street Address *
(example: 123 Anywhere St.)
City *
(example: Town )
State *
(example: MD)
Zip Code *
(example: 12345)
Special Delivery Instructions
Phone Number *
(example: 123-456-7890)
E-mail Address *
Materials *
Select the product(s) and quantities you would like to order. Each toolkit contains one copy of the following items: Guidebook, Quick Guide, Law Sheets, Retailer Checklist, Window Cling, Sticker, Magnet, Pledge, and Poster. To view the materials visit: dhmh.maryland.gov/notobaccosalestominors/Pages/Educational%20Materials.aspx 
No thanks
10
20
50
100
Other
Toolkits--temporarily out of stock
Quick Guides
Stickers
Magnets
If "Other" enter the items and quantities here
*Based on availability
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