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| Information Sheet for Idaho Health Care for All |
750 Views |
| posted on Saturday, October 06, 2007 |
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Idaho Health Care For All
Information Sheet
Name: _________________________________________________________________
Address________________________________________________________________
(Street / City, State / Zip code)
Telephone _____________________________ Mobile phone _____________________
Fax __________________________________________________________________
Email _________________________________________________________________
Profession: _____________________________________________________________
____ My $25 membership, payable to: Idaho health Care For All (IHCFA), is enclosed
____ I would like to receive email updates from Idaho Health Care For All
____ I would like further information about ___________________________________
_______________________________________________________________
I am willing to:
____ Host an information session at my home
____ Talk to colleagues about IHCFA
____ Arrange a speaking engagement for the following organization: __________________
____ Participate in speakers’ training
____ Participate in grand rounds
____ Write a letter to the editor
____ Write a guest column
____ Participate in a news conference
____ Assist with the IHCFA website
Please return to: IHCFA
PO Box 44214
Boise, Idaho 83704
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