Request for
1997-1998 Directory Listing
and
Change of Address Form
Date _____________________
Please check one:
_____ I m not included in the current directory and would like to be included
in the next one
_____ I am included in the current directory but am submitting change of
address information
Name ______________________________________________
Organization ________________________________________________
Address ______________________________________________
Phone _____________________
The next directory will be published in Spring 1997. You will be sent a
directory listing questionnaire in Winter 1996. Those in the current directory
will automatically be sent a questionnaire--you do not need to send in this
form unless your address has changed.
Mail/Fax to:
Diabetes Control Program
P.O. Box 26110
Santa Fe, NM 87502-6110
Phone (505) 827-2953
Fax (505) 827-0021
Table of Contents