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Women's Health in the States:
Current Issues & Trends Seminar Form
Name |
_______________________________________ |
Phone |
_______________________________________ |
Organization |
_______________________________________ |
Address |
_______________________________________ |
City, State |
_______________________________________ |
Zip Code |
_______________________________________ |
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Yes I will attend the seminar on December 11, 1998. (There is no cost for this event.) |
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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. |
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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
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