Information Request Form

**To request an educational resource, please contact PACD (see below) and provide the following information:

Click Here to download this form in MS Word.

Your name: _________________________________________

Mailing Address: _____________________________________
__________________________________________________

Telephone: __________________________________________
Fax: _______________________________________________
E-mail: _____________________________________________

Type of materials: _____Print _____Video _____Slide Program _____Exhibit

Title of Item: _________________________________________
Quantity: ________

Target Audience: _____Self _____Farmers _____Local Government _____Teachers _____Students ____Other:___________________

Please describe the reason you are requesting this information. If applicable, please include the type of event or activity the material(s) will be used: ______________________________________________

_____________________________________________________

Send the form to PACD:
25 North Front Street
Harrisburg, PA 17101
Or by fax to 717-238-7201
To contact PACD call 717-238-PACD (7223)

Questions or comments may also be addressed to:
shannon-wehinger@pacd.org