Discount Order Form
Focus on Alternative and Complementary Therapies (FACT)
I would like to order the following (price in US dollars):
____ 1 year subscription (print plus online access) @ $171
Please send my order to:
| Name |
_____________________________________ |
Address |
_____________________________________ |
|
_____________________________________ |
| |
_____________________________________ |
Telephone |
_____________________________________ |
Email |
_____________________________________ |
Payment must be made by credit card.
____ Please charge credit card: Type _________ Card
# ________________________
Name on
card _______________________________ Expiration date: ________
Signature
___________________________________
To receive your discount, mail or fax this form to:
Heidi Shumate, Pharmaceutical Press, 100 South Atkinson Road,
Suite 200 Grayslake, IL 60030
Fax (847) 543-1768.
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