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Ryan White Reauthorization Campaign Needs You!

October 2005

Please Sign Up to Help

Simply print out this form, check off one or more of the boxes below, fill in your name and contact information, and fax it to Greg Smiley at AAHIVM at 202-659-0976.

Yes, I want to be part of the Ryan White ACTION Campaign. I am willing to:

Name:

Street Address:

City, State, Zip:

Telephone:

Mobile Phone:

Fax:

Email Address:

*The AIDS Institute, HIV Medicine Association, and National Alliance of State & Territorial AIDS Directors




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