Publication Request Form

                       FAMILY VIOLENCE RESEARCH PROGRAM

            Family Research Laboratory, University of New Hampshire
                         Durham, New Hampshire  03824
                 Phone: (603) 862-1888     FAX: (603) 862-1122


BOOKS:   Order from Publisher

ARTICLES WITH AN * before the identification code can be requested using
this form.  Please list those you want.  The prices shown after each item
represent the cost of reproduction.  If you can contribute this amount, it
will help cover our expenses.  But please do not ask us to bill you
because we are not set up to do this.  Make checks payable to Family
Research Laboratory. 

OTHER ITEMS:  These may be available directly from the author.  See list
of addresses at end of bibliography. 

Please indicate the publication code number (e.g. V6, VA6) and price for
each item: 

  #     Price          #     Price         #     Price        #     Price
_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____
_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____
_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____
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_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____
_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____
_____ $ _____        _____ $ _____       _____ $ _____      _____ $ _____


We would appreciate your indicating                     Subtotal  $______
YOUR WORK (Circle one or more):                         Postage   $ 2.50 
1.    College/University teacher
2.    Researcher                                        Total     $______
3.    Human Service provider
4.    Undergraduate student               Send items listed above to:
5.    M.A. student
6.    Ph.D. student                        _______________________________
7.    Other
                                           _______________________________
YOUR RESEARCH ON FAMILY VIOLENCE:
1.    Library study                        _______________________________
2.    Empirical study completed
3.    Empirical study in process           _______________________________
4.    Empirical study planned