Safe Food For Children Order Form
Date:__________________
Check Number______________
Purchase Order______________
| Item |
Unit Cost |
Quantity Mailed |
TOTAL |
| 1. Safe Food For Children Video |
$ 40.00 |
$_________ |
$__________ |
| (Lesson 1-5 featuring Mike the Microbe) |
|
|
|
|
|
|
|
| 2. Safe Food For Children—Leader's Guide |
$ 10.00 |
$_________ |
$__________ |
| (Lesson 1-5 to coordinate with videos) |
|
|
|
|
|
|
|
|
Orders of |
Orders of more |
|
|
1-10 |
than 10 |
|
| 3. Lesson #1 |
|
|
|
| A. Brochure: Clean Hands for Healthy Children |
$.30 |
$.25 |
$__________ |
| B. Handwashing Activity Page |
$.30 |
$.25 |
$__________ |
|
|
|
|
| 4. Lesson #2 |
|
|
|
| A. Brochure: On Your Mark, Get Set Go Grocery Shopping |
$.30 |
$.25 |
$_________ |
|
|
|
|
| 5. Lesson #3 |
|
|
|
| A. Brochure: Microbe Foiled Again |
$.30 |
$.25 |
$_________ |
| B. Magnet |
$.85 |
$.75 |
$_________ |
|
|
|
|
| 6. Lesson #4 |
|
|
|
| A. Brochure: Microbe Family Get Away |
$.30 |
$.25 |
$_________ |
| B. Set of three Food Storage Charts |
$1.25 |
$1.00 |
$_________ |
|
|
|
|
| 7. Lesson #5 |
|
|
|
| A. Brochure: Clean Kitchen Savvy |
$ .30 |
$ .25 |
$_________ |
| B. Certificate of Participation |
$ .35 |
$ .30 |
$_________ |
|
|
TOTAL RECEIVED |
$_________ |
|
Payment or purchase order must accompany your order!!
Make checks payable to Kansas State University, send order to Extension
Human Nutrition, 207 Justin
Hall, Manhattan, KS 66506-1407 Phone: 785-532-1670 FAX: 785-532-1678.
Name_____________________________________________________________________
Street_____________________________________________________________________
City________________________________ State_________________
Zip______________
Phone Number______________________________FAX
Number_____________________ |
