Sage Screening Program Outreach / Educational Materials Order Form

The following materials may be ordered free of charge by completing and submitting this form. If you are located outside of Minnesota, please contact your state health department for materials.

Enter quantity for the materials requested and complete all contact information. Please print the confirmation page for your records.

Sage poster for clinic placement featuring:
Size: 8.5" x 11"
Quantity limit: 10

Descriptions	Quantity
Caucasian woman	Caucasian woman clinic placement posterCaucasian woman
African American woman	African American woman clinic placement posterAfrican American woman
American Indian woman	American Indian woman clinic placement posterAmerican Indian woman
Hispanic woman	Hispanic woman clinic placement posterHispanic woman

Your answer to question Poster_Clinic (Quantity) must be a whole number.

Your numeric answer for question Poster_Clinic (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Clinic (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Clinic (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Clinic (Quantity) does not fall within the range of 0 to 10.

Sage poster for community placement featuring:
Size: 8.5" x 11"
Quantity limit: 10

Descriptions	Quantity
Caucasian woman	Caucasian woman community placemenrt posterCaucasian woman
African American woman	African American woman community plaement posterAfrican American woman
American Indian woman	American Indian woman community placement posterAmerican Indian woman
Hispanic woman	Hispanic woman community placement posterHispanic woman

Your answer to question Poster_Community (Quantity) must be a whole number.

Your numeric answer for question Poster_Community (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Community (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Community (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Community (Quantity) does not fall within the range of 0 to 10.

Sage Spanish poster for:
Size: 8.5" x 11"
Quantity limit: 10

Descriptions	Quantity
Clinic Placement	Clinic Placement poster - SpanishClinic Placement
Community Placement	Community placement poster - SpanishCommunity Placement

Your answer to question Poster_Spanish (Quantity) must be a whole number.

Your numeric answer for question Poster_Spanish (Quantity) does not fall within the range of 0 to 10.

Your numeric answer for question Poster_Spanish (Quantity) does not fall within the range of 0 to 10.

Free mammograms flyer featuring:
Free mammograms 1/3 page includes Sage Program eligibility criteria
Quantity limit: 200

Descriptions	Quantity
Caucasian woman	[mammflyercauc.PNG]Caucasian woman
African American woman	[mammflyerafam.PNG]African American woman
American Indian woman	[mammflyeramin.PNG]American Indian woman
Hispanic woman	[mammflyerhisp.PNG]Hispanic woman
Hmong woman	[mammflyerhmng.PNG]Hmong woman

Your answer to question Mammogram_Flyer (Quantity) must be a whole number.

Your numeric answer for question Mammogram_Flyer (Quantity) does not fall within the range of 0 to 200.

Your numeric answer for question Mammogram_Flyer (Quantity) does not fall within the range of 0 to 200.

Your numeric answer for question Mammogram_Flyer (Quantity) does not fall within the range of 0 to 200.

Your numeric answer for question Mammogram_Flyer (Quantity) does not fall within the range of 0 to 200.

Your numeric answer for question Mammogram_Flyer (Quantity) does not fall within the range of 0 to 200.

Free mammograms flyer available in:
Free mammograms 1/3 page includes Sage Program eligibility criteria
Quantity limit: 200

Descriptions	Quantity
Spanish	[mammflyerspa.png]Spanish
Hmong	[mammflyerhmg.PNG]Hmong

Your answer to question Mammogram_Flyer_Lang. (Quantity) must be a whole number.

Your numeric answer for question Mammogram_Flyer_Lang. (Quantity) does not fall within the range of 0 to 200.

Your numeric answer for question Mammogram_Flyer_Lang. (Quantity) does not fall within the range of 0 to 200.

Free Pap test flyer available in:
Free Pap test 1/3 page includes Sage Program eligibility criteria
Quantity limit: 200

Descriptions	Quantity
English	[papflyereng.PNG]English

Your answer to question Pap_Flyer (Quantity) must be a whole number.

Your numeric answer for question Pap_Flyer (Quantity) does not fall within the range of 0 to 2147483647.

Your numeric answer for question Pap_Flyer (Quantity) does not fall within the range of 0 to 2147483647.

"Free mammograms & Pap tests" table tent featuring:
Quantity limit: 5

Descriptions	Quantity
Caucasian woman	[mammtentcauc.PNG]Caucasian woman
African American woman	[mammtentafam.PNG]African American woman
American Indian woman	[mammtentamin.PNG]American Indian woman
Hispanic woman	[mammtenthisp.PNG]Hispanic woman

Your answer to question Mammogram_Table_Tent (Quantity) must be a whole number.

Your numeric answer for question Mammogram_Table_Tent (Quantity) does not fall within the range of 0 to 5.

Your numeric answer for question Mammogram_Table_Tent (Quantity) does not fall within the range of 0 to 5.

Your numeric answer for question Mammogram_Table_Tent (Quantity) does not fall within the range of 0 to 5.

Your numeric answer for question Mammogram_Table_Tent (Quantity) does not fall within the range of 0 to 5.

"Free mammograms & Pap tests" table tent available in:
Quantity limit: 5

Descriptions	Quantity
Spanish	[mammtentspa.PNG]Spanish

Your answer to question Mammogram_Table_Tent_Lang. (Quantity) must be a whole number.

Your numeric answer for question Mammogram_Table_Tent_Lang. (Quantity) does not fall within the range of 0 to 5.