National Uterine Fibroids Foundation

Patient Brochure Order Form

Please fill out the information below, print this page and mail it with your check to:

National Uterine Fibroids Foundation
PO Box 9688
Colorado Springs, CO 80932

First/Last Name:
Organization:
Address:

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Home Phone:
Office Phone:
Fax:
E-mail Address:
Brochure(s) Requested: (50 brochures per pack)	Treatment Options for Uterine Fibroids Resources and References It's All About...Quality of Life			Quantity: Quantity: Quantity:		Other: Other: Other:
Amount Enclosed:		Other:	$