SCAN would be happy to send you a copy of Five Wishes. Please complete the form below. Five Wishes is available in both English and Spanish (Cinco Deseos). Please indicate your language preference. Allow 7-10 days for delivery.

Member Name	First	Last
Your Name	First	Last
Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Language Preference	English Spanish