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Women's Health in the States:
Current Issues & Trends
Seminar Form
Name _______________________________________
Phone _______________________________________
Organization _______________________________________
Address _______________________________________
City, State _______________________________________
Zip Code _______________________________________
_______ Yes I will attend the seminar on December 11, 1998. (There is no cost for this event.)
_______ I would like to become a member of the Jacobs Institute and receive invitations to future seminars as well as a subscription to the journal Women's Health Issues, the newsletter, In Touch , and a copy of State Profile on Women's Health. Please find my check for $55.00 or my credit card information enclosed.
_______ I would like to order an audio tape of the seminar for $15.00 (member price:$12.00) plus $3.50 shipping and handling.  My check or my VISA/MasterCard information is enclosed.
Visa/MasterCard _______________________________________
Exp. Date _______________________________________

Please print form.

Please RSVP by fax, mail, or e-mail (no phone calls , please) with this reply form (click here for from) by December 8, 1998 to Monica Barbour, Jacobs Institute of Women's Health, 409 12th Street, SW, Washington, DC 20024-2188

Phone (202)863-4990 Fax (202)488-4229 E-mail