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Home > Issues > Medicare > Rx Drug Center >  Request a Copy of the New Walter Cronkite Video

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New Medicare Drug Program Video Copy Request Form

Please fill out this form to request a DVD or VHS copy of the video:
(All fields are required)

First name:
Last name:
Organization:
Email:
Shipping Address:
City:
State/Province:
Postal Code:
Video Format:
Copies requested:
When/where do you plan to show the video?
Phone:
   
     
 

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