Request Materials

Please complete this form to request that DTV educational materials to be sent to you.

Fields marked with * are required.

Contact Information

Your Name*

Organization (if any)

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone number*

Email address*

Materials Requested

Please enter how many you need of each item. Enter 0 for any items that you do not need.

Flyers (Please indicate number needed for each language requested)

English

Spanish

Coupon Request Forms (Please indicate number needed for each language requested)

English

Spanish

Cambodian

French

Hmong

Korean

Lao

Russian

Simplified Chinese

Tagalog

Traditional Chinese

Vietnamese

Nursing Home Residents

Other Materials

DTV Converter Box Ratings (Consumer Reports)

How to Install a Converter Box

Local List of Certified Retailers

Additional Information

Where do you plan to distribute materials?*

Notes/Comments

The Leadership Conference on Civil and Human Rights