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