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Jacobs Institute of Women's Health
Publications Order Form
Please print out the following form, fill out and mail or fax to the following address:
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Jacobs Institute of Women's Health
409 12th Street, SW
Washington, DC 20024-2188
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Phone: 202-863-4990
Fax: 202-488-4229
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| Name and Title: |
_______________________________________ |
| Organization: |
_______________________________________ |
| Street Address : |
_______________________________________ |
| City |
_______________________________________ |
| State/Zip: |
_____________________ |
| Phone (area code first): |
( ___ ) ____ - _________ |
| Fax (area code first): |
( ___ ) ____ - _________ |
| E-mail address |
______________ @ _____________________ |
Please send me the following information (free of charge):
| / / |
Information about the Jacobs Institute |
| / / |
Jacobs Ortho-McNeil Scholar Research Award Information |
| / / |
Internship Opportunities |
| / / |
Other _________________________________ |
Please send me the following items:
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Item
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Qty. |
Price |
Total |
| Regular Membership |
_____ |
$55.00 |
$__________ |
Guidelines for Counseling
Women on the Management
of Menopause |
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$7.50 |
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Womens Health and
Managed Care:
Opportunities for Action |
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$15.00 |
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| State Profiles |
_____ |
$30.00 |
$__________ |
| Women's Health Data Book 2nd Edition |
_____ |
$28.95 |
$__________ |
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Women's Health Data Book 3rd Edition
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_____ |
$33.00 |
$__________ |
Women's Health Issues
(specify volume and issue no.) |
_____ |
$21.50 |
$__________ |
| Insights |
_____ |
$25.00 |
$__________ |
| Value Purchasing: Investing in Women's Health - Strategies for Employers |
_____ |
$15.00 |
$__________ |
| _________________________ |
_____ |
$__________ |
$__________ |
| _________________________ |
_____ |
$__________ |
$__________ |
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Shipping charges:
| # of Items |
Shipping Charge |
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1-2
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$3.50
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3-9
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$6.50
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10-20
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$10.00
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Shipping:
$__________
Total Amount Due:
$__________
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Please enroll me as a member of the Jacobs Institute.
(For details on membership, click here.)
Please select one:
| / / Regular ($55) |
/ / Contributor ($100) |
/ / Supporter ($250) |
| / / Institutional ($250) |
/ / Corporate ($1,000) |
Payment Method:
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/ / Check (mail to address below) or
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/ / VISA/MasterCard (please circle selection)
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Account Number ______ - ______ - ______- ______ Expiration Date __ / ____
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Cardholder's name ___________________________
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Note: Members may take a 20% discount on publications, audio tapes and resource packets. Invoicing available for orders of 10 or more only.
WE DO NOT ACCEPT RETURNS.
PAYMENT MUST BE RECEIVED PRIOR TO SHIPPING.
Help the Institute continue to provide acclaimed programs, projects, and publications by making a tax-deductible donation toward its effort of advancing the knowledge, practice and understanding of women's health. Total amount enclosed: $ _____________
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