UVideo Challenge Materials Order Form

UVideo Challenge logo

Contact Information (All Required)

Materials

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Enter number of copies [limit 5 per item]:



The information collected on this form will be used to mail the UVideo Challenge promotional materials that you request. By submitting this order, you agree to allow the Minnesota Department of Health to contact you regarding Challenge promotion. Your information will not be used for any purpose other than communications regarding the UVideo Challenge. You are not required to provide the data requested on this form.  However, if you do not provide the data, the Minnesota Department of Health might not be able to provide you the materials requested.