PRINT FORM

University at Albany
School of Public Health

Preconception Care Video



Please send one free copy of the Preconception Care satellite broadcast on February 27, 2003. I understand that these will be available while supplies last on a first come, first served basis.

         Specify format: ___ VHS tape ___ DVD ___ Audiotape

Name _______________________________________________________________

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Phone (____)______________ E-mail _________________________________

Print form and mail or fax to: Continuing Education, School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144-3456
Fax: 518-402-1137