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Department of Health and Human Services
Commissioned Corps of the U.S. Public Health Service American Indian / Alaska Native Commissioned Officers Advisory Committee (AIANCOAC) AIANCOAC Coin Order Form |
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Rank/Name_______________________________________________________________________ Department of Health and Human Services (HHS) Operating Division/Staff Division or non-HHS organization_______________________________________________________________ City__________________________________________________________State____Zip__________ Address__________________________________________________________________________ Phone number ____________________________E-mail___________________________________ Number of coins ________________ Total $__________________ Coins are $10 each. Make check/money order payable to: AI/AN Commissioned Officers Advisory Committee |
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Please print form and mail or deliver to: CAPT John M. Coleman, USPHS Director, Pharmacy Services Santa Fe Indian Hospital 1700 Cerrillos Road Santa Fe, NM 87505 John.coleman@ihs.gov For a description of the coin logo, please visit http://www.aiancoac.freeservers.com/whats_new.html |
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