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Request for Educational Material

Please take the time to fill out the following information regarding your educational material request. We would prefer this form to be filled out four weeks prior to your event to allow us the best possibility in assisting you.
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Name
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Email
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Telephone
Address1
Address2
City
State
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Zip
  

Event Information

If the materials you are requesting are being used at an event, please provide the following.
Name of the Event:

Educational Material Information

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Please list the materials you are requesting.
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Who is the target audience?
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How many people do you expect to reach?
Date of the event
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Please explain the purpose of the items you are requesting.
Location of the Event/Health Fair
What are the event goals?
How many years has this event been held?
Please list how you will advertise this event.
List any other organizations participating in this event.
Your materials will need to be picked up at the following address: 4901 Forest Park Ave., Suite 1221 Saint Louis, MO 63108
Find a doctor or make an appointment:
General Information: (314) 747-3000
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
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