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AFWA Resource Order Form _Organisations_ 2010

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					                                     Asthma Foundation of WA Inc
                                     Resource Order Form 2010 (organisations)

                                     Email: reception@asthmawa.org.au | Fax: 9289 3601
                                     Post: Asthma Foundation of WA, PO Box 864, West Perth, WA, 6872
                                     ABN: 57 057 873 242

Name:                                     Organisation:
Postal Address:                                             Suburb:
Post Code:         Phone:                 Email:
Please invoice me (minimum order $20 plus postage)
Please charge my credit card (minimum order $10 plus postage)
Credit card details:                               Expiry:
Signature:……………………………………………..Card type: Visa               Mastercard
The primary purpose of collection the personal information that you supply on this form is to process your order. The
Asthma Foundation will not disclose your information to a third party without your written permission. For more details of
the Asthma Foundation of WA privacy policy, please visit our website: www.asthmawa.org.au or call us on 9289 3600.
                                                         Community Resources
                                                                 Amt                                                         Amt
                Resource                      Cost         Qty                     Resource                  Cost      Qty
                                                                  $                                                           $
 Community Asthma Education                                              Other AFWA Publications
                                                                         Asthma Awareness and Airways
 "Ask the Asthma Educator" Brochure            free                                                           free
                                                                         A3 Poster
                                                free
 "Helping Kids Breathe Better" Activity                                  Asthma Awareness and Airways
                                               (max                                                           free
 Book                                                                    A4 Poster
                                             50/order)
                                                                         “Helping People Breath Better”
 Fax Referral Form for GP's, Hospitals and
                                               free                      Brochure and Membership              free
 Pharmacies
                                                                         Form
                                                                         Caring for your child's asthma       free
 Asthma Child and Adolescent
                                                                         booklet (written in conjunction     (max
 Program (ACAP)                                                          with PMH)                          5/order)
 ACAP Asthma First Aid Poster (A4)             free                      Asthma Shop Retail Catalogue         free
                                                                         "My Asthma" booklet for
 ACAP Asthma First Aid Poster (A3)             free                                                           free
                                                                         children
                                                                         Asthma and pregnancy - tips to
 ACAP Asthma First Aid Fridge Magnet           free                                                           20c
                                                                         help you stay well
                                                                         Asthma Australia
 Asthma at School for School Staff             15c
                                                                         Resources
 Asthma Can’t Stop Me – Primary Schools        AFS                       Asthma Australia Brochure Series:

 Air Traffic Control – Secondary Schools       AFS                       Asthma: the basic facts              20c
 Asthma Week (only available                                             Asthma medications and
                                                                                                              20c
 during August)                                                          delivery devices
 Asthma Week (1-7 September) Display
                                               free                      Asthma in the under 5s               20c
 Kit
                                                                         Asthma: take control; great tips
                                             TOTAL                                                            20c
                                                                         for teenagers
                                                                         Asthma and aged care facility        20c
                                                                         residents
                                                                         Asthma in seniors                    20c
                                                                         A sporting chance with asthma        20c
                                                                         Being active with asthma             20c
                                                                         Asthma at school for school
                                                                                                              20c
                                                                         staff
                                                                         Asthma in the workplace              20c
                                                                         Asthma Australia
                                                                         Newsletter:
                                                                         Asthma Update Magazine               50c
                                                                                                            TOTAL
                                                Community Resources (cont.)
                                                       Amt                                                               Amt
                Resource                Cost     Qty                            Resource                Cost       Qty
                                                        $                                                                 $
Breathe Easy Indigenous Resources                              Fact Sheets (cont.)
Breathe Easy Asthma Information
                                        free                   Pregnancy and Asthma                      20c
Brochure
Breathe Easy First Aid A4 Poster        free                   Royal Jelly                               20c
Breathe Easy First Aid Postcard         free                   The Low Allergen Garden                   20c
Breathe Easy First Aid Wallet Card      free                   Towards the Low Allergen Home             20c
Breathe Easy Educational DVD and
                                        $15                    Travel and Asthma                         20c
Training Brochure
Fact Sheets                                                    Wood Smoke                                20c
                                                               Your 6 Step Asthma Management
Adult Onset Asthma                      20c                                                              20c
                                                               Plan
                                        20c                    First Aid (see also AFS and AFCC lists for specific first
Air Pollution
                                                               aid publications)
Allergy and Asthma                      20c                    First   Aid   Postcards - Magnet          20c
Anaesthetics and Asthma                 20c                    First   Aid   Wallet Cards                20c
Aspirin and NSAID Analgesics            20c                    First   Aid   Fridge Magnets             $1.00
Asthma and Adolescents                  20c                    First   Aid   Poster A4                   15c
                                        20c
Asthma and Exercise                                            First Aid Poster A3

                                        20c                    NAC DL Consumer Brochures
Asthma and Food                                                (A4 health professional versions
                                                               in training section)
Asthma    and Lung Function Tests       20c                    Allergic Rhinitis and Your Asthma         10c
Asthma    and Smoking                   20c                    NAC Consumer DL Brochures:
Asthma    at School                     20c                    1. Asthma and allergy                     10c
Asthma    in the Over 50's              20c                    2. Asthma and lung function tests         10c
                                        20c
Asthma Key Messages 2008                                       5. Asthma and complementary therapies

Asthma, Allergy and Spring – Be         20c
                                                               7. Asthma and diet in early childhood     10c
Prepared!
Babies and Asthma                       20c                    8. Asthma and wheezing in the first years of life
                                        20c                    Department of Health and
Buteyko                                                                                                  10c
                                                               Ageing Publications
Carpets and Vacuum Cleaners             20c                    Asthma Cycle of Care                      10c
Chronic Lung Disease and Shortness of   20c
                                                               Written Asthma Action Plan
Breath
Common Questions                        20c
Complementary Therapies and Asthma      20c                                                             free
Heating and Cooling                     20c                                                             TOTAL
House Dust Mite                         20c
                                        20c
Influenza

Low Allergen Plants                     20c
Managing Asthma in Winter               20c
MSG and Asthma                          20c
Nebulisers                              20c
Occupational Asthma                     20c
Other Medications and Asthma            20c
Peak Flow Meters                        20c
Pets and Asthma                         20c
                                        TOTAL




See page 3 for NAPS and Training resources…
  Newborns Asthma and Parental Smoking Project                                       Training Resources
                                                          Amt                                               Amt
              Resource                   Cost     Qty                           Resource              Cost   Qty
                                                           $                                                  $
                                                                       Professional Asthma Management Training
NAPS Project (order online at
                                                                       (available to download from
www.smokefreebaby.org.au/naps_resources_order.php)
                                                                       www.asthmawa.org.au/training.php)
                                                                       Asthma Foundation
NAPS Resource Order Form                  free                         Professional Training          free
                                                                       Brochure
                                                                       Asthma Educators Course
NAPS Quarterly Newsletter                 free                                                        free
                                                                       Registration Form 2010
                                                                       Asthma Management Course
Packs:                                                                                                free
                                                                       Registration Form 2010
NAPS Care for my air! resource pack
                                                                       Asthma Seminar Registration
(for pregnant and new mothers) –         free*                                                        free
                                                                       Form 2010
includes the brochures below
                                                                       Asthma Workshop
Brochures:                                                                                            free
                                                                       Registration Form 2010
                                                                       Asthma Awareness for
Ways to say "Please don’t smoke"         free                          Pharmacy Assistants            free
                                                                       Registration Form 2010
                                                                       Emergency Asthma
Quitting smoking                          free                         Management Course              free
                                                                       Brochure
                                                                       Emergency Asthma
Important news for fathers who smoke      free                         Management Course              free
                                                                       Registration Form 2010
                                                                       Registration, Payment and
                                                                       Refund Policy 2010 (please
Smoking and your baby (green)             free                                                        free
                                                                       send with any orders from
                                                                       above section)

Posters:                                                               Other Training Resources
                                                                       Asthma and Pregnancy - an
Poster – Be asthma aware                 free*                         information sheet for health   50c
                                                                       professionals
                                                                       NAC A4 Health Professional Brochures (DL
Poster – One of them will have asthma    free*
                                                                       consumer versions in community section)
Poster – There is a better way to care
                                         free*                         NAC Health Professional Brochures:
for my air

Poster – Did you know                    free*                         1. Asthma and allergy          10c
                                                                       2. Asthma and lung function
Training Resources:                                                                                   10c
                                                                       tests
NAPS Indigenous Women's                                                5. Asthma and
                                                                                                      10c
Project:                                                               complementary therapies
NAPS Indigenous Women's Project                                        7. Asthma and diet in early
                                          free                                                        10c
"How your baby grows" booklet                                          childhood
NAPS Indigenous Women's Project                                        8. Asthma and wheezing in
                                          free                                                        10c
"Smoking and your baby" brochure                                       the first years of life
NAPS Indigenous Women's Project
                                          free
"Would you let me smoke" poster

                                         TOTAL


*Maximum order of 10. Maternal and child health professionals
may order larger amounts or find out more about the Newborns
Asthma and Parental Smoking (NAPS) Project by calling (08)
9289 3641 or visiting www.smokefreebaby.org.au.

POSTAGE (by weight):
TOTAL COST:
Office use only:
Purchase Order Number:                                  MYOB Invoice/Receipt:
Add to IMIS?: Yes                   Volunteer assigned:
Form received (date):                            Pack mailed (date):