Miami-Dade AHEC

RECEIVE CORRESPONDENCE

Would you like to know about Miami-Dade AHEC’s latest programs and services? We would love to keep you up-to-date and informed about what’s going on here. Please fill out the form below if you would like to receive correspondence from Miami-Dade AHEC and we will be happy to add you to our direct mailing list and/or our email newsletter list.

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Personal Information
First Name*
Middle Initial
Last Name*
Title
Organization
Address 1*
Address 2
City*
State*
Zip*
Best # to Contact You*
Fax #
Email*
Direct Mail Correspondence
Please check all that apply.
Please add me to your direct Mailing List so that I may receive Brochures on the following topics:	General Miami-Dade AHEC Updates
	PHASES
	Health Careers Programs
	Continuing Education Programs
Please Mail me a brochure or information on the following topics Now:	Tobacco Cessation
	Community Health Services
	Health Careers
	Continuing Education
Email Correspondence
Please check all that apply.
Please add me to your Email List so that I may receive Newsletters on the following topics:	General Miami-Dade AHEC Updates
	PHASES
	Health Careers Programs
	Continuing Education Programs
Please Email me a brochure or information on the following topics NOW:	Tobacco Cessation
	Community Health Services
	Health Careers
	Continuing Education
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