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New to Apraxia
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Brochures and Printables
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Speech Tablets for Apraxia
Community
Blog
Walk for Apraxia
Ways to Give
Awareness
Be the Voice
Support Groups
Media Room
Education
Article Library
On-Demand Webinars
National Conference
Intensive Training
Virtual Education Series
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Be The Voice – Request Point-of-Purchase Kit
Be The Voice- Request Point-of-Purchase Kit
If you are human, leave this field blank.
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*
Last Name
*
Address
*
Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
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Burkina Faso
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Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
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Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curacao
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Czech Republic
Denmark
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Dominican Republic
East Timor
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Israel
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Japan
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Jordan
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Lithuania
Luxembourg
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Mali
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Mayotte
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Montserrat
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Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
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Vatican City
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Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
*
Email
*
Is this your first interaction with Apraxia Kids?
*
Yes
No
What is your relationship to apraxia?
*
Parent
Professional
Family Member
Student
Researcher
I have/had apraxia.
Other
Please provide 1-2 sentences describing how you plan to utilize the Point-of-Purchase stars.
*
How many people will be impacted by your event or initiative?
*
If your event is on a particular day, please provide the date:
Are you using this Point of Purchase as part of your Walk fundraising?
Yes
No
What is your team name and what Walk will you be attending?
Please check here if you are requesting these materials from outside the United States or Canada. Due to the rising cost of shipping, we charge a $10 shipping and handling fee for international orders.
We are excited to offer these kits free of charge to maximize awareness! Would you like to make a donation to help us offset the cost of printing and shipping?
*
Yes!
No, thank you.
Donation Amount (USD):
*
I would like to receive email communication from Apraxia Kids.
Total (USD):
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