Women's Health Policy Forum
"Seeking Social Justice"

February 3 & 4, 2002
LaSells Stewart Center
Oregon State University Corvallis, Oregon

 

Registration Form:

 
First Name *
 
Middle Initial
 
Last Name *
 
E-mail *
 
Your Title
 
Organization
 
Address *
 
City *
 
State/Province *
 
ZIP/Postal Code *
 
Country *
 
Telephone *
 
Fax
 

Can we add your name to the roster provided to forum attendees?
 

What legislation are you most interested in working on?

Registration Fee $30.00
Students $10.00

Please send check or money order to:

Women's Health Policy Forum
c/o Benton County Health Department
PO Box 579
Corvallis, OR 97339-0579
Fax: (541) 766-6899