NYS Health Department “Image Gently” Campaign
Name
Please
Place
Stamp
Here
Address
Phone
Email
Would you like to participate in this NYSDOH “Image Gently” program?
yes
no
How many dosimetry cards would you like
per year?
quarterly?
Bureau of Environmental Radiation Protection
New York State Department of Health
Flanigan Square - Room 530
547 River Street
Troy NY 12180