2004 Pan American Public Health Reporting Awards

Please type or print:

Entry Title: _______________________________________________________

____________________________________________________________________

Publication Date: _______/_______/2004

Entrants Last Name: ________________________________________________

First Name:_________________________________________________________

Affiliation: _______________________________________________________

Address: ___________________________________________________________

City: ___________________________ State: ____ Zip Code: ____________

Day and evening phone numbers:  (        ) ___________________

                                (        ) ___________________

E-mail:_____________________________________________________________


Entry deadline: Must be received no later than April 30, 2005

Please address entries to:

        Pan American Health Organization
        Public Information
        525 23rd Street N.W.
        Washington, D.C.  20037


For additional information, please call Marķa Ida Iglesias at (202) 974-3358
or .