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*Due to limited quantities and messaging specific to school-based health centers, Version 1 is available ONLY to clinics located in Seattle.:

1. First and last name


2. Email address


3. Phone (with area code)


4. Clinic name


5. Seattle, WA mailing address, city and zip code


6. Number of magnets needed for design version 1
(minimum pack quantities — leave blank if you don't wish to order this version)


7. Number of magnets needed for design version 2
(minimum pack quantities — leave blank if you don't wish to order this version)


8. Number of magnets needed for design version 3
(minimum pack quantities — leave blank if you don't wish to order this version)


Version 1:

HPV reminder magnet for health care providers

Version 2:

HPV reminder magnet for health care providers

Version 3:

HPV reminder magnet for health care providers