About the Autumn Series   Select Program East Coast West Coast   Sponsorship Opportunities   Last Year's Summer Series	Request A Hard Copy Catalog You may order multiple copies of the Autumn Series Catalog and distribute them to your friends and colleagues. Complete information is available online here at the Autumn Series website, but if you prefer a printed version, the catalog contains complete session information and a registration form. Please indicate whether you want a catalog for the East Coast or West Coast series, along the number requested. * denotes a required field. Number of copies * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Location * East Coast West Coast First Name * Middle Initial Last Name * Position or Title Organization Street/PO Box * City * State/Province * Alaska Alabama American Samoa Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming ----- Alberta British Columbia Labrador Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Ontario Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Other Zip/Postal Code * Country United States Algeria Argentina Australia Austria Bahamas Bahrain Bangladesh Belgium Bermuda Bosnia Brazil Cameroon Canada Channel Islands Chile Columbia Costa Rica Crotia Cuba Czech Republic Democratic Rep of the Congo Denmark Dominican Republic Ecuador Egypt El Salvador Estonia Finland FOREIGN COUNTRY France Germany Ghana Greece Guatemala Hong Kong Hungary Iceland India Iran Ireland Israel Italy Jamaica Japan Jordan Kenya Korea Kuwait Latvia Lebanon Liberia Malaysia Malta Mexico Mongolia Morocco Nepal Netherlands Antilles New Zealand Nigeria Norway Pakistan Panama Paraguay People's Republic of China Peru Philippine Islands Portugal Republic of Georgia Russia Rwanda Saudi Arabia Senegal Singapore South Africa Spain Sweden Switzerland Taiwan Thailand The Netherlands Togo Trinidad and Tobago Turkey Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Venezuela Wales Zambia Daytime Phone   Ext. Email Address * Email (confirm)* Please indicate whether the American Society on Aging may send you email about its programs: Yes, send me email, I understand that I can always ask to be removed from any ASA email list. No, don't send me email. Comments:

Copyright © 2010 American Society on Aging; all rights reserved. American Society on Aging 71 Stevenson St., Suite 1450 San Francisco, CA 94105-2938 www.asaging.org info@asaging.org