2012 African American History Calendar - Order Form

2012 African American History Calendars are available for $4 each. You may order a maximum of 5 calendars while quantities last. Please complete and mail (postal) this form with your check made payable to Aetna.

Mail to: 
Aetna African American History Calendar
Corporate Communications
151 Farmington Avenue, RW3H
Hartford, CT 06156

Name _______________________________________

Address _____________________________________

City _________________________________________

State ________________________________________

Zip __________________________________________

Phone _______________________________________

Quantity ________ Total $ _______________________