Indoor Environments Network Change in Radon/IAQ Program Information Form Contact Person Information Update Make changes to your organization's contact person here. Please print legibly and include all information listed. Organization: Previous Contact Name: New Gontact Name: Title: Primary Address: P.O. Box Address: ' __ (if applicable) City: ; . State: Zip: Voice Phone: ( ) \ Fax: ( ) E-Mail Address: . Website Address: National Partner Organization Affiliation: Effective date of change / / Check all that apply: Q I still have an active Radon and/or IAQ program. > a I do not wish to be included in the printed Directory. Q I no longer have a Radon/IAQ program and wish to be deleted from mailing lists. Program Expertise Please indicate your area(s) of experience and/or which issue your program addresses: Q Radon Awareness, Testing & Mitigation Q Medical/Public Health Care Professional in Asthma Treatment & Environmental Health Issues Q Radon-Resistant New Construction Q Indoor Air Quality in Schools • Q Indoor Air Quality in Large Buildings Q Asthma Awareness and Prevention Q Environmental Tobacco Smoke or Secondhand Smoke in Children's Health U Other Related Programs Not Listed (please list): Fax or mail the form to: IEN Coordinator The Cadmus Group, Inc. 1901 N. Fort Myer Dr. Suite 900 " ' _ Arlington, VA 22209 Fax: (703) 247-6001 E-Mail: IENcoordinator@cadmusgroup.com ------- |