Diabetes Educator Brochures Order Form

Brochures may be ordered in quantities of 100 for $20.

Quantity desired: ________pkg of 100 brochures @ $20 each pkg.  =  $___________  

                                  Shipping and Handling = $4.00 per 100 ordered=   $___________

                                                                                                         Total=  $___________

Please pay by check made out to" MeADE "

Send brochures to:

Name:_______________________________________

Institution:____________________________________

Address:______________________________________

_____________________________________________

Phone number in case of questions:_________________________________

Mail your order form with check enclosed to:

Rena Gels-Birch

Diabetes Endocrine and Nutrition Center

EMHM     Suite 11

905 Union St.

Bangor, Maine 04401