AMSSA Publications Order Form

Please send copies of
Please send copies of
Please send copies of
Please send copies of

to: Contact Name:
Organization Name:
Delivery Address:	City, Province and Postal Code and or PO Box
Telephone:
Fax:

Payment Method:
We would like to be invoiced - (for institutions/organizations only).
Cheque enclosed $ (See price list )
Credit card Visa or Mastercard

Credit Card Information:

Card Holder Name (as it appears on the card):
Card Number:
Expiry Date:
Signature:

and fax it to: (604) 298-0747
or mail to: 205-2929 Commercial Drive, Vancouver, British Columbia, Canada, V5N 4C8