Registration

for October 12, 1999 2-3:30pm ET

New Health Status Indicators in the MCH Block Grant

Name: 
Title:  
Organization:
Address:
City:  
State: 
Zip Code:  
E-Mail Address: (required)
Telephone #:
Fax: 
Comments:

           

IMPORTANT REGISTRATION INFORMATION:

Participants in the audioconference will be able to participate in one of two ways: Live via the Internet, or over the telephone (conference call). Please let us know which one you are registering for.

PLEASE CHECK ONE (after reading above):

Please register me for participation in the audioconference via the Internet.
Please register me for participation in the audioconference via conference call.

If you cannot register online, print out and send this form to:

Ms. Isha Fleming, MCH Information Resource Center

1200 18th Street, Suite 700, Washington, D.C. 20036

(202) 842-2000,

or fax to (202) 728-9469