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2016 MIDWESTERN REGIONAL CONFERENCE

State of the Black Health: Living Well in the 21st Century
AUGUST 5 7, 2016

DVD Order Form

($25.00 per DVD plus shipping)

Black Health

Name: ___________________________________________________________________________________
(Please print your name and address clearly)
Address: ________________________________________________________________________________
City: ____________________________________

State:________________ Zip:_________________

Email: ___________________________________________________________________________________
Videophone:__________________________Text:___________________Voice:___________________

_____ Midwestern Regional BDA Conference DVD x $25.00 per DVD

_____ ADD Postage, flat rate $2.00 no matter how many DVDs ordered

Total enclosed: _______________

Cashiers check, Money Order or PayPal accepted. PayPal is in the process of being set up. Please
bear with us. MAIL PAYMENT AND THIS FORM TO: Buckeye Black Deaf Advocates, ATTN:
Stacy Woods, BBDA Vice President, P.O. Box 13608, Columbus, Ohio 43213.
Any questions or concerns, please contact Stephanie Smith Albert at
2016mwrchair@gmail.com
www.buckeyebda20.weebly.com