NIH R&W Classified Ad Application
Classified rates effective July. 21, 2004

There are 20 spaces per line, with 10 lines maximum.
$15.00 for 1-5 lines of type (100 spaces maximum)
$25.00 for 6-10 lines of type (200 spaces maximum)

To place your classified ad, simply fill out this form and return it to:

DEADLINE:  Your completed form must reach us by the 15th of the month to be placed in our next edition of the newsletter. (Ex. Oct 15th is deadline for November edition). The R&W newsletter is distributed at the beginning of the month.

NOTE: The R&W Association reserves the right to reject any copy submitted. WE do not accept classifieds for weight loss or work from home ads.

Mark one category only:

Prepayment is required. We accept cash, checks, or MC/VISA. Make checks payable to NIH R&W Association. Please do not fax form unless paying by credit card. Your ad will not be considered until payment is received. If paying by Mastercard or Visa:

Print cardholder name __________________________________________________

Cardholder's signature __________________________________________________

Account number ______________________________________________________

Expiration date ______________________  Amount to be charged _______________

Daytime phone number ___________________  Evening phone __________________