| 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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