National Inhalant Prevention Coalition
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contact NIPC at: (855) 704-4400

e-mail:nipc@prismnet.com
NOTE: If you are also interested in joining the National Inhalants & Poisons Awareness Campaign, fill out the following information below and indicate your interest in the large comment box. Please let us know about the level of inhalant use in your community and how you found out about NIPC.

Please take a moment to fill in the following form:

name

organization

I'd like to help the NIPC with a contribution or
make a voluntary payment for resources:

Yes, please contact me.

position / occupation

address

city

state

zip code

country

phone number & area code

fax number & area code

e-mail

How did you hear about the National Inhalant Prevention Coalition?

In the space below, please tell us about your interest in inhalant information.
Have there been inhalant related deaths in your community?
If you are with an organization, what services do you provide?
Which inhalants are a problem in your area?
Do you have a specific question regarding inhalants?
Are you seeking treatment for someone you know with an inhalant problem?

If you require a reply or would like info on NIPAW, NIPC will attempt to contact you as soon as possible.


Please enter the letters in the above image.



   

 


 

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