WIC ORDER FORM – “Feeding Your Baby” Magazine Series

NWA “Mom Strong” Magazine Series

Order now and give WIC families a healthy start

The information provided within these brochures helps to educate WIC recipients, increase caseload and provide:

Information on eligibility
What WIC can offer caregivers
Call, Text and website signup options

Contact Information
Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email
Phone
Tell us about your location
Describe the services provided at your location (check all that apply)*
- Maternity Ward
- Birthing Center
- Prenatal Care
- WIC center
- Health Department
- Other
Other*
How many babies do you delivery annually?*
How many 8 Page WIC Brochures would you like to receive annually?*
Other*