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Oasas.state.ny.us Order Form for Rental of Videotapes(s) and/or DVD(s) Please Note: All requests must be prepaid. City, State, Zip: Telephone: City, State, Zip: Date of this order: Intended Use: Ship to: E-Mail: Organization: Street Address: Contact Person: VIEWING SELECTION DATE PREPAID ACCT. CHECK ENCLOSED Ext: Staff Training (Part 822) Patient /Group OASAS ALTERNATE SELECTION(S) USE (If 1st choice is not available) or or or or or or or or Submit Via Em.

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