CT Clearinghouse

Problem Gambling Materials Order Form

If you would like to request problem gambling materials, please fill out the form below.

(* Denotes Required Fields)

Contact Information
First Name: *
Last Name: *
Organization/Agency: *
Email Address: *
Confirm Email Address: *
Phone Number:
Print Resources and Materials Requests
Please specify quantities of requested materials below  
Brain Biology - English :
Brain Biology - Spanish :
What About You - Spanish:
Choices and Guidelines Booklet:
Responsible Play the CT Way Bag :
PRIDE Chip Clips:
Computer Webcam Cover:
College Stylus Pens:
College Infinity Fold :
Know the Risks Pamphlet :
Responsible Gambling Guide (Chinese):
Play Safe Flyer (Chinese):
Responsible Gambling Guide (Vietnamese) :
Voluntary Self Exclusion Process Flyer (Vietnamese):
Spend Wisely in College (Vietnamese):
Play Safe Flyer (Vietnamese):
Poster Requests
Please note there is a limit of 10 for each poster requested 
Know the Risks Warning Signs - English :
Know the Risks Responsible Gambling :
Know the Risks Why it Matters - English :
Know the Risks Why it Matters - Spanish :
Know the Risks Before You Gamble:
"Can You Rank the Risks?" Activity Set Requests (Limit 5 Sets)
"Can You Rank the Risks?" activity sets are limited to five (5) sets per organization, coalition, school, or business. Please list the number of activity sets needed and plans for their use in the spaces provided below. 
Number of sets (limit is 5 per organization): *
Please describe plans for use:: *
Requested materials and posters will be used for
Please check all that apply: *
Pick Up/Mail
Note: Shipment takes approximately 2 weeks  
Please select one: *
If shipment is chosen, please submit a shipping address 
First Name :
Last Name :
Organization/Agency :
Address:
Address 2 :
City :
State:
Zip Code:
Email Address:
Phone Number:
Additional Notes :
Any questions or requests can be sent to Cathy Sisco at csisco@wheelerclinic.org