Putting Down Roots In Earthquake Country: Handbook Order Request Form

Putting Down Roots in Earthquake Country
Fall 2008 Edition

For 10 or fewer copies, use the simple request form.

Application for more than 10 copies of this handbook:

We may contact you for further information if necessary before shipping. Booklets come in boxes of 100 each; this form allows an organization to order up to 200 copies of the handbook. To order more than 200 copies, please call Mark Benthien at 213-740-0323 to discuss arrangements for pickup or delivery.

Copies are shipped free of charge, courtesy of the California Emergency Management Agency.

First Name	Last Name
Organization
Mailing Address
City	State	ZIP Code
E-mail Address
Phone number
Number of copies:

Please answer the following questions:
Where did you hear about this handbook?
Have you identified hazards in your home (heavy items that can fall on you during shaking, unsecured water heaters, etc.) and begun to fix them?
Have you created a disaster plan?
Have you created a disaster supply kit?
Have you identified your home's potential weaknesses (house not bolted to foundation, unbraced cripple walls, etc.) and begun to fix them?
Do you know how to protect yourself during an earthquake?
Please answer these questions with as much detail as possible:
Who will receive the handbooks? (family, friends, customers, employees, community group, general public, etc.)
How will they be distributed? (Mail, class, training, special event, information desk, etc. Include location and dates of distribution if known, and how they will be used.)
How often might you need a similar supply of these handbooks? (quarterly, yearly, as needed, etc.)
We will review your application and contact you if we need more information or if we will not be able to send you the quantity requested. Otherwise, your order will be shipped within 2-3 weeks.