24th Annual Minority Health Conference
March 1, 2002

Request form for videotapes of the
William T. Small, Jr. Keynote Lecture by Sherman. A. James, Ph.D.
(VHS format only)

Payment of $12 per tape (by check or money order only, please) will be required in advance. Please send payment to
Minority Health Project, Attn: Raj Kiran Medapalli
Department of Maternal and Child Health
University of North Carolina at Chapel Hill
Campus Box 7445, Chapel Hill, NC 27599-7445.

Make the checks payable to "School of Public Health/Minority Health Conference"

Orders must be received by April 30, 2002 and payment (check or money order) by May 15, 2001. We expect videotapes to be shipped by the vendor in June 2002.

Please provide the information below and then click the REQUEST TAPE button.
Items marked with an * are required.

*Name
*First
Middle
*Last
Job
Job title / position
Occupation
Agency
Name
*Mailing address 
*City
U.S. state or territory

If not U.S.
Non-U.S. state or province
Country 		 
*Postal code
*Postal code 		   
Telephone
*Day telephone (with area code)
Fax number (with area code) 		 
E-mail Address 
  I would like to receive announcements (maximum 12 / year) 
about minority health / public health events or news?     Yes  No 
 

How many tape(s) of the William T. Small, Jr. Keynote Lecture by Dr. Sherman. A. James, would you like to order?

Payment of $12 per tape (by check or money order only, please) will be required in advance. Prices includes shipping and handling.

 

Comments? 

Disclaimer
This form generates an unsecure email to the Minority Health Project, UNC-CH School of Public Health. 
         

We will confirm your request within two weeks. If you have not received a confirmation within two weeks of submission, please send e-mail to Minority_Health@unc.edu to check on the status of your request.

Updated 02/03/2002raj, 03/24/02raj Minority_Health@unc.edu