REGISTER BY FAX OR MAIL

If you are unable to register online for any reason, please download the printer-friendly registration form  (updated form available shortly). This form should be printed, completed, and faxed to 202-552-5868 or mailed (along with a check, if applicable, for the appropriate amount) to:

340B Health
P.O. Box 825410
Philadelphia, PA 19182-5410

Please make checks payable to 340B Health.

For your data security, please do not email credit card information.

 
Printer-Friendly Registration Form