Mailing Lists

Request Form

All fields are required

Name

Department

E-mail
This is the e-mail address to which we’ll send the list.

Phone ( ) -

Purpose of List

Please tell us how you plan to use the list.

Categories to include in List

Please be as specific as possible. If you have questions, please call Public Affairs at (316) 293-2643.
Example: Internal Medicine, FT/PT Paid Faculty OR Pediatrics, All Volunteer Faculty

Address Preference
Recipient’s Preference Home Business

Document Format
Word Excel

Need Date
Please allow at least 5 business days when possible.

Agreement

Upon submitting this request:

I agree to safeguard the information I receive and will only use it for the purpose I’ve stated.
I will not disclose or sell this information to another party.
I will ensure that any agents or subcontractors I use agree to the same restrictions and conditions in writing.
I will destroy all information received after each mailing.

Agree