Office of Community Affairs

The University of Medicine & Dentistry of New Jersey's Department of Community Affairs maintains a mailing list on health care providers, professionals, community and faith-based organizations for the State of New Jersey. To help us update our mailing list, please complete the following items listed below.

If you have any questions, please contact Anthony Valentine at (973) 972-6364 or valentak@umdnj.edu.

Prefix (e.g. Mr./Ms., Assemblyman, Senator etc.)
Suffix (e.g. MD, BA, etc.)
First Name
Middle Initial
Last Name
Title
Division
Organization/Corporation Name
Street Address/ Room/Suite
City
State	US AK AL CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip
Contact Person
Office Phone
Fax
Other (i.e. mobile, pager)
E-mail Address
Website
List other groups/organizations with which you are affliliated:
List other appropriate agencies for our mailing list:
Name of additional contact person from your organization that you would like to include on our mailing list.
Telephone Number
Title
E-mail Address
Completed By
Date