PHA Free Materials Order Form

Envelope of Hope An information kit for newly diagnosed patients Action Kit includes step-by-step guides for a variety of advocacy, awareness, fundraising, and special events opportunities QTY: PHA Membership Brochure QTY: PH: Helpful Information for Patients and Families QTY: 10 Things to Do When You, Your Child or Someone You Love is Diagnosed with Pulmonary Hypertension QTY: PH Clinicians and Researchers (PHCR) brochure PHA’s membership section for physicians and doctorate-level researchers working in the field of pulmonary hypertension. QTY: PH Resource Network brochure PHA’s membership section for non-physician healthcare professionals working in the field of pulmonary hypertension. QTY: Awareness poster QTY: Wallet Card QTY: General Inquiry Packet New to PHA? General Inquiry Packet General information which includes the above materials (except those for medical professionals) and even more. QTY:   Name: Address: City: State: Zip: Phone: E-mail: Is this for Awareness Month? Yes No If requesting more than 10 copies of any item, please complete the following: Event/ Activity: (e.g., Booth/table at event, support group meeting, fun-walk, materials for doctors’ offices) Date of event/ activity: xxxxx

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