Middle Cities Risk Management Trust
The Trust C.A.R.E.S.
C
ommitment Advocacy Responsiveness Education Service

Video Library Order Form

Please provide the following information:

District:
Name:
Street Address:
City:
State:
Zip Code:
Telephone:
Fax:
E-mail:

Please refer to the library listing and enter the item code(s)
for each video you wish to borrow. You may request as
many videos as you wish, however a maximum
of two videos are loaned out at one time.
Please prioritize your choices.

       Code #1       Code #2    
   Code #3      Code #4

To complete your order, click on the "submit form" button below.

By submitting this form, you agree to return all
videos within 30 days.