NAHUC Mailing List/Labels Request For Members

NAHUC will make available to its members the NAHUC mailing list and/or labels containing the names and addresses of NAHUC members for the purpose of promoting educational and/or research services to health unit coordinators.  NAHUC members have the opportunity to decline to be on the list by checking a box on the new membership form.

 Instructions

Complete request and submit to the NAHUC Office.  Once approval is obtained from Region Representative, NAHUC will process request and bill requestor.  Please allow 2-4 weeks for processing.

Requestor Information

Name:	 

Address:  

City:	       State/Province:  Zip/PC: 

Daytime phone #  NAHUC member # 

Type of Information Requested

Mailing List

Self-adhesive Mailing Labels

Regions and/or States Requested:

Purpose of Request (how list/labels be used):

 I agree to use the list or labels only for educational or research purposes as listed above.  I agree that I will not to make, sell, use, re-use, reproduce, make available to others, distribute, disclose or otherwise utilize the mailing list or information contained therein.  I indemnify the NAHUC Board of Directors from any liability arising out of the activities for which the list or labels were used.

Signature of Requestor: ______________________________________________

Date of request: ___________________________________________________

Office Use only:

Region Representative approval obtained :

 National Association of Health Unit Coordinators
1947 Madron Road    Rockford, IL 61107-1716
888-22-NAHUC     (f) 815-633-4438
[web site form]