Please send me my Preventing Drowsy Driving Among Shift Workers Program materials.
 
Print out this form then check the program materials you need and fill in the quantity in the spaces provided. Please note, you may order a maximum of one guide, which includes the PowerPoint training sessions: one video; one set of six posters; and 50 of each brochure. Although NHTSA places a limit on the number of materials that can be ordered, camera-ready artwork and a master video can be ordered to reproduce larger quantities as needed. Fax this form to NHTSA at 202-493-2062. Please print clearly.
     
Materials  
Quantity
"Preventing Drowsy Driving among
Shift Workers" Employer Administrator's Guide, which included the Training and Education Session on PowerPoint
_____
"Wake Up and Get Some Sleep" Video
_____
"Better Sleep" Posters for the Workplace, Set of Six posters
_____
"Sick and Tired of Waking Up Sick and Tired?" Brochure for Shift Workers
_____
"A Wake-Up Call for the Whole Family" Brochure for Shift Work Families
_____
"The Top 10 Tips for Shift Workers" Tip Card
_____
(A maximum of one video; one set of six posters; and 50 of each brochure may be ordered.)
 
Your Name ____________________________________________
Company or Organization ____________________________________________
Address ____________________________________________
  ____________________________________________
City/State/Zip ____________________________________________
Phone ___________________________________Ext._______
 

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