Connection in Action Materials Order Form

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Home/Connection in Action Materials Order Form

Connection in Action Materials Order Form

If you would like printed copies of any of Connection in Action’s information materials, please complete this form.

Your Contact Information:

Name of your organization, business, or group

Your name

First Last

Your email address

Your phone number

Requested Materials (check all that apply)

Postcard

Information Sheet for Older Adults

Brochure

Information Sheet for Community and Organizations

Am I At Risk? sheet

Older Adult Social Supports Service List

View Materials: Postcard, Information Sheet for Older Adults, Brochure, Information Sheet for Community and Organizations, Am I At Risk? sheet, Older Adult Social Supports Service List

Number of Postcards

Number of Information Sheets for Older Adults

Number of Brochures

Number of Information Sheets for Community and Organizations

Please indicate the area(s) in which you are requesting printed copies (check all that apply)

Burlington

Halton Hills

Milton

Oakville

Delivery Preference

Please note our pickup location:
Acclaim Health
2370 Speers Rd, Oakville, ON L6L 5M2

Your Delivery Address

Street Address Address Line 2 City Province Postal Code

Preferred Pickup or Delivery Date

MM slash DD slash YYYY

Preferred Pickup or Delivery Time

Morning

Afternoon

Evening

Please note that while we aim to deliver your order by the date requested, delivery will depend on quantity of available stock and availability of delivery team.

Additional information (delivery instructions, etc.)

Download the Materials Order Form as a PDF

Download PDF File

Connection in Action is advised by Halton’s Older Adult Isolation Action Table and is an initiative of Halton’s Community Safety and Well-Being Plan.

Contact Us

Phone: (905) 844-2299
Email: Hello@ConnectionInAction.ca
Twitter: @HaltonCIA
Facebook: @HaltonCIA

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About Connection in Action
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Connection in Action Materials Order Form
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About Connection in Action

About Social Connections

Get Involved

Connection in Action Materials Order Form