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HIV Prevention Media Campaign Order Form

Directions: Fill out this form, print it out on your printer and mail with a check for $20 to ZAP, P.O. Box 5590, Cortland, NY 13045. Or, call 607-753-5374 for more information. Files are in .jpg format on a zip disk. Back to HIV Prevention Media Campaign page.

Name  
Organization  
Street Address  
City  
State  
Zip Code  
E-mail  
Phone  

Cortland County Health Department
60 Central Avenue
Cortland NY 13045
607-753-5374
YWCA
14 Clayton Avenue
Cortland NY 13045
607-753-9651
Cortland Youth Bureau
25 Court Street
Cortland NY 13045
607-753-3021