NAHUC Mailing List/Labels Request Form

NAHUC will make available to its members the NAHUC mailing list and/or labels containing the names and addresses of NAHUC members for the purpose of promoting educational and/or research services to health unit coordinators.  NAHUC members have the opportunity to decline to be on the list by checking a box on the new membership form.

 

Instructions

Complete request and submit to the NAHUC Office.  Once approval is obtained, NAHUC will process request and bill requestor.  Please allow 1-2 weeks for processing.

Please provide the following information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Choose one of the following options:


Regions and/or states requested:


Purpose of request (how list/labels will be used)


As the person requesting this information, I agree to use the list or labels only for educational or research purposes as listed above.  I agree that I will not to make, sell, use, re-use, reproduce, make available to others, distribute, disclose or otherwise utilize the mailing list or information contained therein.  I indemnify the NAHUC Board of Directors from any liability arising out of the activities for which the list or labels were used.

Enter the date of request:


National Association of Health Unit Coordinators, Inc. (NAHUC)
1947 Madron Rd    Rockford, IL 61107-1716
888-22-NAHUC     (f) 815-633-4438   office@nahuc.org
Copyright © 2003 [NAHUC, Inc}]. All rights reserved.
Revised: 03/23/09