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Mouth Power Online

Your scouts earn their MouthPower patches by bringing you these two items:
  • A MouthPower Online Certificate with their name on it;
  • The poster or packaging design they printed from the Creativity Corner.
Once the troop/group has completed these activities, fill out the following report, remit your payment, and we will send their patches to you.
* Your Organization:
    Junior Girl Scout
    Girl Scout
    Cub Scout
    Boy Scout
    Boys & Girls Club
    Other:

Your Troop/Group Number:

Your Council Number:

* Your Contact Information:
          Name
          Phone
          Email
          Mailing Address

* Number of patches earned:

* Total: $3 per patch. (Maryland residents, please add 5% tax)

Please make your check made payable to University of Maryland/NMD and send it to:

National Museum of Dentistry
Attn: Director of Education
31 South Greene Street
Baltimore, Maryland 21201

* Comments about your experience with MouthPower Online:
(We value your comments and will use them to evaluate our program)

* Required Information

Please list the children in your troop/group who completed MouthPower Online (earned Completion Certificate and created a poster or package design about peer pressure and tobacco in Creativity Corner):

Name

Game Code (printed on certificate)

Age


IMPORTANT!
Please print this page and send it in with your payment.

Submit Report

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MouthPower Online © 2004 University of Maryland Baltimore/The Dr. Samuel D. Harris National Museum of Dentistry. MouthPower and Mouthie are trademarks of the University of Maryland Baltimore. The MouthPower Online Web site was developed by Educational Web Adventures - www.eduweb.com - and is generously supported by UnitedHealthcare Dental and the California Dental Association Foundation.