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Company/Organization
___________________________________________________
Contact Person
___________________________________________________
Address
___________________________________________________
Advertising Authorized by
___________________________________________________
Signature / Position
________ / _________________________________________
Telephone / Date

DATE OF INSERTION (please check)

___ March, 200__ (closes on December 1)
___ June, 200__ (closes on March 1)
___ September, 200__ (closes on June 1)
___ December, 200__ (closes on September 1)

SIZE OF ADVERTISEMENT (please check)

___ Full page, 6 1/2" (width) x 9" (depth)..................$ 500
___ Half page, 6 1/2" (width) x 4 1/4" (depth)............$ 300
___ Quarter page, 3 1/4" (width) x 4 1/4" (depth).......$ 175
___ Eighth page, 3 1/4" (width) x 2" (depth)..............$ 100

___________________________________________________
Product Advertised

Classified Advertising (limit 70 words, 50¢ per word, print clearly or type):
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

$______________
Amount enclosed

Full payment must accompany advertisement insert request, payable to ICEA in US funds drawn on US bank. Send ICEA Journal advertisement insertion request, camera-ready ad copy and/or classified ad content with full payment to:

International Journal of Childbirth Education
Attn: Advertising
1500 Sunday Dr. Suite 102
Raleigh, NC 27607 USA

Retain copy of this request for your records.