The Epidemiology Monitor Newsletter - ORDER FORM

This form is for customers who are not comfortable submitting credit card information over the Internet. Please print out the form, and fax it to us at: 770/594-0997, or you may mail it to:
The Epidemiology Monitor, 2560 Whisper Wind Court, Roswell, GA 30076, USA.

Step 1 of 3: PLACE YOUR ORDER

Name:

Type:

 New Subscription Renewal
Company:
Address:
City:
State:
      Zip Code:
Country:
Telephone:
Fax:
E-mail:
Student*
$ 45.00 		           Personal
$ 50.00		            Institution
$80.00
Special Offer: Free T-shirt or Hat with a One year subscription. Both a free hat & t-shirt with a Two year subscription.


Forign Subscribers must add $20 for Air Mail.
* Student subscribers must FAX copy of student ID to: 770/594-0997

 

 

Step 2 of 3: Provide Subscriber Information (If different from Step 1.)

Name:
Company:
Address:
City:
State:
      Zip Code:
Country:
Telephone:
Fax:
E-mail:

 

Step 3 of 3: Select A Payment Method

A - Payment by Check: Print and complete order form. Send order form and check to:
The Epidemiology Monitor, 2560 Whisper Wind Court, Roswell, GA 30076 USA
All checks must be in US funds drawn on a bank with a US address on the check.

B - Charge credit card:

Mastercard       VISA
Name on credit card:
Credit card account number:
Credit card expiration date:


C - Issuing purchase order for total amount:
     P.O.#:
     FAX to purchase order to: 770/594-0997

D - Send an invoice to the address in Step 1.