ORDER INFORMATION
Name of person placing the order:__________________________________________
Institution _____________________________________________________________
Street/P.O. Box ________________________________________________________
City/State/Zip or Postal Code______________________________________________
Country ______________________________________________________________
E-Mail _______________________ Daytime Ph. _______________________
Purchase Order Number ___________________________
Please bill my ___MasterCard ___VISA ___American Express ___Discover
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Acct. No.
___ ___ / ___ ___ ___ ___
Exp. Date
__________________________________________
Signature (Required)
Mail this entire form and payment (in U.S. dollars) to: Phi Delta Kappa International, Subscription Dept., P.O. Box 789, Bloomington, IN 47402-0789, Phone: 800/766-1156. Or fax the form with your credit card information to: 812/339-0018. |